WWE-D Restraint
The two forms of physical restraints utilized by Ascension. Two types, at least four names.
Non-Violent or Non-Self Destructive (Medical)
&
Violent or Self-Destructive (Behavioral)
A patient states “I’m tired and ready to go, and not taking anymore test.” This patient is probably leaving______
AGAINST MEDICAL ADVICE
Every patient receives a score during triage/admission.
They don’t have to wait on the mail from South America to get it.
CSSRS
Columbia Suicide Severity Rating Scale
A ten (10) item scale used in the assessment and management of alcohol withdrawal.
Clinical Institute Withdrawal Assessment for Alcohol
CIWA or CIWA-Ar (shorter version)
The time interval between assessments/documentation for individuals in Violent or Behavioral restraints assist in evaluating readiness for discontinuation of restraints
Every 15 minutes
This patient is 1:1 face to face at all times
Restraints will be discontinued by an RN or Physician at the earliest possible time.
To sign or not sign
That is the question
AMA Form
Ideally the patient should sign, however if they refuse to sign indicate by writing “Patient refused to sign”. Be certain that Provider is aware of AMA
Answering “Yes” to 4, 5, or 6 on the CSSRS won’t add up but give you a ratio instead that requires undivided attention
1:1 Observation
Do the math
Ten (10) assessment areas
Seven (7) points for nine areas
Four (4) points for one area
For maximum CIWA score
67
Nausea or vomiting 7
Tremors 7
Anxiety 7
Agitation 7
Paroxysmal Sweats 7
Orient. Clouding of Sensorium 4
Tactile Disturbances 7
Beside keyed leather restraints, it’s another form of restraint. This can be used only in Behavioral Health Unit
Seclusion
(continually monitored in person, through use of both video and audio equipment, assessment recorded every 15 minutes)
The responsibility a healthcare facility, with an ER has to render medical care to individuals within 250 yards of the main hospital property, regardless of ability to pay
EMTALA Law
A patient answers "yes" to question 3 or 6 of the CSSRS (Moderate Risk). This may be appropriate (Not exceeding 12)
What is visual surveillance?
Withdrawal symptoms were tolerable, for the first 4-6 hours. Toward the end of the second day you can really feel it. Literally feel it and it can kill.
Delirium Tremens aka DT’s
Early signs and symptoms of alcohol withdrawal usually <48 hours: tremors and tactile disturbances, diaphoresis, HTN, increased temperature, tachycardia, insomnia, restlessness, appetite loss, hyperactivity, nausea/vomiting, cravings
Later signs, usually >48 hours: confusion and hallucinations, shaking, shivering, irregular heart rate, seizure
Time frame from initiation of restraint until restraint is discontinued.
Restraint Episode
“I think you need urgent care instead of coming to the ED. There is no need to be seen here.” Seemingly harmless this could be considered______________
EMTALA VIOLATION
ALL patients should receive basic medical screening and transferred if the facility is unable to manage
Code V on the color spectrum, it is also the code after violent or aggressive behavior has been displayed.
CODE Purple
CIWA score >25 indicates severe withdrawal. A score of 9-15 may necessitate the use of these medications into the regimen. Hey man, chill out
Barbituate
Phenobarbital Oral or IV
The information that should be documented in OC (One Chart)
Alternatives to restraints, clinical justification for use, patient’s physical, and emotional well-being and non-physical methods to be used in the future.
How did we get to this point.
Education
A patient in the ICU is being transferred to a higher level care. The patient is on vasopressors and has a sudden drop in hemodynamics. The ACLS ambulance crew is ready to leave. Continuing transfer at this point would be a EMTALA violations because________?
Unstable patients can not be transferred under EMTALA Law
The inherent risk found in a typical exam room. It is anything which could be used to attach a cord, rope or any material used for the purpose of hanging or strangulation
Ligature Risk
Given to prevent Wernicke encephalopathy.
(An acute disorder manifested by confusion, ataxia, and ophthalmoplegia, as well as the chronic Korsakoff syndrome, which is manifested by memory impairment and amnesia)
What is Thiamine?