[Old_School]

I'm not one to editorialize <yeah,right> but I have a problem with the Joint Commission. Back in the day, all patients on ventilators had to be restrained. This was policy. Nurses had no discretion to remove restraints on awake alert cooperative patients. I was never a big fan of this practice. Joint Commission came in several years ago and said that restraints only with a doctor's order that had to be renewed on a daily basis. This was a good thing, it allowed us to determine if the patient really needed restraints. They then followed up with strict guidelines for restraints and our reactionary administration took restraints off the supply cart altogether. It pretty much requires an "Act of Congress" to get restraints these days. However, the use of "mittens" is not considered a restraint and is now used pretty liberally. Joint Commission now want to deem mittens a restraint and put them under the same guidelines as wrist restraints. Caring for intubated patients can be difficult. Some patients are so restless and combative that no amount of sedation seems to work. If these patients are not restrained they will whip that tube out in a literal heartbeat. I feel that soon all our tools will be taken away from us and more patients will be unnecessarily harmed because of traumatizing self extubation and the equally traumatizing reintubation. Don't even get me started on the side rail thing.

O_S

[grapejam88]

Don't worry OldSchool...JCAHO may take away our restraints, our mitts, all forms of restraint, but they won't take away all of our spare ETT and trachs. We will just have to stock up on those so that we have enough to meet the demands of reintubations and trach reinsertions for our patients actively DT'ing and crawling up the walls. Perhaps once we reintubate enough patients, pay for enough broken bones from confused patients falling out of bed, etc., the insurance companies will wreak holy hell on JCAHO about their mamby pamby restraint baloney.