Wednesday, October 04, 2006

Your Truth: Chemical vs. Physical Restraints

Another hypothetical scenario for your consideration...

This patient is an 86 y.o. female with dementia who is actively dying. She has become delirius, but still has the strength to get out of bed and is at a high risk for falling and injuring herself from the fall. In addition, she has a intravenous (IV) line that is being used for pain medicine that she keeps trying to pull out. The doctor has suggested the use of sedating medications to keep her from pulling out her line and from falling. But the family states they would like to keep her alert and thus they refuse the medications offered. Instead, the family prefers that wrist restraints are applied, tying the patient to the bed rails to prevent falls and to prevent the IV from being pulled out. NOTE: Both types of restraints are avoided while the family is visiting, but the family leaves to sleep at night.

1. What education could be offered to the family to ensure they are fully informed of the options to ensuring this patient's safety?

2. What other options might be considered beyond pharmacological or physical restraints?

3. What are your own feelings about chemical verses physical restraints and how might these feelings impact your attitude towards this family's decisions?

2 comments:

Arrow said...

1. What education could be offered to the family to ensure they are fully informed of the options to ensuring this patient's safety?

First of all get a personal alarm for the pt. If she tries to get up staff is notified immediately and can respond. There are no physical restrain options anymore anyway... at least not in hospice.

2. What other options might be considered beyond pharmacological or physical restraints?

There is always one on one. Consider bringing in volunteers. Encourage family to be present. If the patient is still alert enough to sit up she could be placed in an area where observation is possible.

3. What are your own feelings about chemical verses physical restraints and how might these feelings impact your attitude towards this family's decisions?

I like chemical restraints better if applied correctly.
Since she is having terminal agitation perhaps Haldol should be tried. She may need some ativan. If given in low dosages and applied correctly the patient should not be over drugged into unconsciousness. The family needs teaching about the changes of LOC that are anticipated anyway. The family also needs to be made aware that terminal agitation is not comfortable for the patient. These behaviors are distressing and cannot facilitate a peaceful death. This family needs lots of EOL teaching and guidance. You do not medicate a patient to please a family member, nor should you not medicate to please a family member. The choice and need of medicine should be based on the patients needs in accordance with the physician or hospice nurse and determined through an ongoing educational process with the patients medical POA.

And loose that IV somewhere. A subcutaneous line with a PCA pump should be able to give any medication that a person who is terminal should need. A second butterfly can be placed for other prn meds. Now you have eliminated all the risks of IVs and have access for medicinal administrations that are about painless and have multiple site possibilities.

nelc said...

hello, nice post and comment too. im enlightened, i really would not knowwhat to do if i were in that situation.