Excessive Restraints

[Oz girl]

The longest physical restraint in September 2004 was 8:41 AM till 11:25 AM... thats a long time for all those monkeys to be sitting on you

Shit.. I think in the some states it is actually illegal to restrain someone continously for that long.

Only in some states??

[ZenAgent]

Words of Warning to the Medical Staff
“Psychiatric hospitals are under a
microscope...Everyone is upset about how you
use restraints. The 60 Minutes Show reflects the
peoples’ perceptions of your hospital. You are
obligated to make them change their minds...It is
a challenge to be attentive and thoughtful with
restraints. Some hospitals put their staff and
physicians in them to see what it is like. And in
every case those staff and physicians will be less
likely to use restraints. It’s a question of
dignity. Restraints are dehumanizing. You must
ask yourselves: Are you using them only when
you’ve tried everything else?â€

[ZenAgent]

Department of Health and Human Services

http://oig.hhs.gov/oei/reports/oei-04-99-00150.pdf[/url]

(Extract, pg. 11)

Time Limits


HCFA’s new Patients’ Rights Condition of Participation limits the duration of each written restraint or seclusion order to 4 hours for adults, 2 hours for adolescents age 9 to 17, and 1 hour for children under age nine. Original orders may be renewed for up to a total of 24 hours before requiring a second face-to-face physician or licensed independent practitioner evaluation.

State Policies

The State policies in 43 percent of the States limited restraint and seclusion orders in public psychiatric hospitals to between 1 and 4 hours in duration. Conversely, only 9 percent of the States had a similar limit for restraint and seclusion orders in private psychiatric hospitals. Table 3 shows State policies for time limits on restraints and seclusion for both public and private psychiatric hospitals.

As Table 3 shows, 11 percent of the States did not establish physician order time limits for public psychiatric hospitals. Almost 35 percent of the States did not establish physician order time limits for private psychiatric hospitals. In such instances, the hospitals
established their own policies.

Seven of the 15 States told us their State policy varied between 1and 4 hours in duration for physician orders in public psychiatric hospitals. The time limits varied depending on a patient’s age. All seven State policies were identical to the new Condition of
Participation: 4 hours for adults, 2 hours for adolescents 9 to 17 years of age, and 1 hour for children under 9 years of age. None of the State policies for private hospitals made this distinction.

The mental health professionals we interviewed agreed that restraint and seclusion physician orders should be time limited. They said patients should be frequently evaluated and released as soon as possible. The importance of this guidance was emphasized by the Hartford Courant article that related a death to a lengthy restraint. In that instance, a 38 year-old man died from medical complications after being restrained to a bed for 18 hours.

Such adverse outcomes highlight the importance of frequently evaluating patients who are restrained or secluded. A short time limit on restraint and seclusion physician orders requires frequent oversight and evaluation of patients.

[Anonymous]

http://studentnurseca.blogspot.com/2005 ... raint.html

[Anonymous]

[img]http://www.deuterio.net/photoplog/images/1/1_xenu-pam.jpg[img]

[Anonymous]

[Nihilanthic]

Why on earth should restraint ever go on past an episode of an outburst?

One hour is too long, a full hour is rather obviously a punishment. All periods of time longer than that are rather obviously to punish the person acting out as well.

Extended periods of time in restraint (unwillingly) is torture, plain and simple.

I don't get how people excuse this.  ::T::

[Anonymous]

http://studentnurseca.blogspot.com/2005 ... raint.html

10 year-old Francisco was having a bad day, and loosing a Volleyball game sent him over the edge. He pushed down another kid and started running a very foul mouth.

Staff Intervention #1: Removed other children from the area and assigned a staff member to "talk him down." This involves calming words and setting limits verbally.

Francisco continued to swear at the staff member. Then, he picked up a chair as if to though it.

Staff Intervention #2: Placed Francisco in the Quiet Room (a padded room with a bed) with a staff member in the doorway. The staff member continued to talk him down.

Francisco continued to swear, and then spit at the staff member and on the walls.

Staff Intervention #3: Required that Francisco take a sedative, either in pill or shot form.

Francisco refused the pill, so a rapid takedown using as little force as possible to get the job done. He was then left to rest in the quiet room with a staff member watching from the doorway.

I was impressed that this team took every step possible to prevent a forced takedown and chemical restraint. I'ts not perfect, but three cheers for progress in Psychiatry care.

[ZenAgent]

http://studentnurseca.blogspot.com/2005 ... raint.html

10 year-old Francisco was having a bad day, and loosing a Volleyball game sent him over the edge. He pushed down another kid and started running a very foul mouth.

Staff Intervention #1: Removed other children from the area and assigned a staff member to "talk him down." This involves calming words and setting limits verbally.

Francisco continued to swear at the staff member. Then, he picked up a chair as if to though it.

Staff Intervention #2: Placed Francisco in the Quiet Room (a padded room with a bed) with a staff member in the doorway. The staff member continued to talk him down.

Francisco continued to swear, and then spit at the staff member and on the walls.

Staff Intervention #3: Required that Francisco take a sedative, either in pill or shot form.

Francisco refused the pill, so a rapid takedown using as little force as possible to get the job done. He was then left to rest in the quiet room with a staff member watching from the doorway.

I was impressed that this team took every step possible to prevent a forced takedown and chemical restraint. I'ts not perfect, but three cheers for progress in Psychiatry care.

Three cheers... for Francisco, "running a very foul mouth" and picking "up a chair as if to though (sic) it".  The lad's competitive in the All-American style.  Francisco's day was indeed bad.  The "rapid takedown" involved enough force to jam a pill in his mouth or stick a needle in him, and isn't that a chemical restraint?  They like to use a little benzodiazepine at PV, according to records.  Not only does it reduce the kid to Jell-O, it has the added benefit of fogging the memory.  However, there is a risk:

Paradoxical reactions

Severe behavioral changes resulting from benzodiazepines have been reported including mania, schizophrenia, anger, impulsivity, and hypomania.[31] Individuals with borderline personality disorder appear to have a greater risk of experiencing severe behavioral or psychiatric disturbances from benzodiazepines. Aggression and violent outbursts can also occur with benzodiazepines, particularly when they are combined with alcohol

(Wikipedia)

[Anonymous]

The "rapid takedown" involved enough force to jam a pill in his mouth or stick a needle in him

I assumed when I read it that they forced him down onto the floor in a prone position, pulled his pants and underwear down and jammed his butt with a syringe.

From the comments section (a health inspector):

Sounds like your hospital has a good policy and actually uses restraint the way it's intended to be.

[Anonymous]

Staff Intervention #2: Placed Francisco in the Quiet Room (a padded room with a bed) with a staff member in the doorway. The staff member continued to talk him down.

How did he get to the "Quiet Room"?

[Ursus]

Seems like there is a huge gap in between Intervention #s 2 and 3.  Does spitting necessitate a sedative in response these days?

[Anonymous]

"It's a very suppressive drug," said Breggin, the director of the International Center for the Study of Psychology and Psychiatry. "This drug is like putting cement in the brain of a child."

Isn't Peter Breggin a Scientology cult guy?

[TheWho]

Seems like there is a huge gap in between Intervention #s 2 and 3.  Does spitting necessitate a sedative in response these days?

The spitting in and of itself doesn’t necessitate a sedative, I can agree with that.  The spitting episode was a clear sign that the staff wasn’t going to be successful in talking down Francisco.  This seems like a good example of controlling a situation from getting out of hand.. Removing the other kids from the area… trying to talk to the child before moving on to restraints.  I cant see anything that could have been added to the procedure that would have improved things any.  Does anyone else?



...

[Anonymous]

Seems like there is a huge gap in between Intervention #s 2 and 3.  Does spitting necessitate a sedative in response these days?

The spitting in and of itself doesn’t necessitate a sedative, I can agree with that.  The spitting episode was a clear sign that the staff wasn’t going to be successful in talking down Francisco.  This seems like a good example of controlling a situation from getting out of hand.. Removing the other kids from the area… trying to talk to the child before moving on to restraints.  I cant see anything that could have been added to the procedure that would have improved things any.  Does anyone else?



...

Yeah, I worked for several years in two of the "industry's" worst shit-pits.  NEVER, not even once, EVER, did I have to put my hands on or restrain a child in any way.  It's simply not necessary.  A skilled clinician never needs to resort to violence against a child.  I proved that personally for years and I had some of the "worst" kids ever admitted.