Crisis Prevention and Intervention in Healthcare - Essay Example

Essay Inserts His/Her Inserts Grade Inserts (21 02, Outline Introduction. 2. Least restrictive measure 2.1. Restraining techniques 2.2. Psychological restrain 2.3. Seclusion and Exclusion 2.4. Mechanical restraint and Four-point restraint 2.5. Restraining procedure 3. Appropriate use of medications as chemical restraints 3.1. Medication categories 3.1.1. Butyrophenones 3.1.2. Benzodiazepines 3.1.3. Benzodiazepines and Butyrophenones 3.2. Atypical antipsychotics 3.3. Effects of chemical restraints 3.4. Administrations of chemical restraints 3.5. Implications of chemical restrain 4. Conclusion. Crisis prevention and Intervention in healthcare 1. Introduction. Restraining patients is a challenge because it could lead to injuries. The presence of a qualified healthcare professional is therefore considered necessary. Restrain prevent harm and can assist in diagnosis as well as implementation of treatment. Guidelines and policies on restrain are provided by regulatory bodies to ensure that the restrain is only given when necessary and does not cause danger to the patient. To understand the concerns surrounding restrain, this essay discusses restraining techniques and appropriate use of chemical restrain. Emphasis is placed on a restrain free environment. 2. Restraining techniques Patients in crisis can be a threat to others and to self. Restraining entails restricting the arms, legs and tying the waist to reduce or contain mobility. Patients can be confined in hospital willingly or unwillingly. Restrain prevents a patient from moving their head, body, arms or legs freely. Items used to facilitate medical examination such as bandage are not considered restrain. 2.1. Least restrictive measure Measures to restrain patients with assaultive behavior are carefully selected because restriction or seclusion could lead to negative outcomes if excessively implemented. Therefore, recommended measures should be least restrictive and steered towards specific result. Restraining techniques are recommended only when necessary. Restraining can be granted if the patient or family request. Advice for restrain by the healthcare professional should be accompanied by the length of time the assaultive person should be restrained. Observations should be made when the patient is restrained and recorded at regular intervals. Reviews can be made to assist the patient overcome their condition. Restraining is not used as a convenient way of containing the patient when healthcare professionals want to discipline the assaultive patient. Additionally, healthcare professionals should be aware of the body alignment when implementing least restriction to avoid body injuries. The patient should be able to change movement and exercise. Body circulation is important to enable the body to continue functioning as Ballard and Rockett (2009, p. 34) mention. 2.2. Psychological restrain Psychological restrain may precede chemical restrain and physical measures to restrain. Psychological restrain is given in the form of a program or a therapy. Activities are designed to meet the diverse situation of the assaultive behavior by withholding certain privileges. The privileges withdrawn do not include the basic needs. The patient given retrain will have access to shelter, clothing and food. Patients undergoing psychological restrain can interact with family, healthcare professional and attorney. Psychological restrain is part of treatment which can be prescribed as a therapy. 2.3. Seclusion and Exclusion Seclusion implies that a patient is placed in a separate area from others where the room is locked. When a patient asks to have own room that is open, it is not seclusion. A patient is not in seclusion if they are locked in a room because there is a quarantine to prevent spread of disease. The room where an aggressive patient is secluded is not locked if the patient is a child. The room is often watched and secured. Safe and soft items are availed for the aggressive patients to vent. The objective of putting an aggressive patient in seclusion is not only to cause harm, but also to prevent the patient from becoming aggressive by reducing factors that encourage violence as Lewis and Ford (2000, p.34) discuss. Seclusion is given after least restrictive policies are not effective. Exclusion takes place when a patient is moved from a one place to another restricted area. Patients with mental disorders who persistently do not cooperate with management intervention may be excluded from the other patients with mental disorders. Exclusion is different from seclusion because in exclusion the room is not locked while in seclusion the room is locked. Rooms for patients in exclusion are constantly monitored, since the assaultive patients are allowed to vent. Seclusion and exclusion are a reserve of the physician’s recommendations and should be limited. The healthcare professionals should remove dangerous items that can be used to cause harm from the room. Such items include clothing which can be used for strangling. Seclusion and exclusion cannot be administered on patients with substance overdose, tendencies of self-harm and is suicidal. 2.4. Mechanical restraint and Four-point restraint There are situations where the aggressive patient has acute violent behavior. The healthcare professional designs a mechanical restraint plan recognizing the imminent danger to self and others. The plan indicates how the restrain is to be done. Healthcare professionals trained to restrain aggressive patients use straps, wristlets, ankles, lockable buckles and muffs. The patient may be allowed certain movements at specified intervals. Mechanical restrain should be applied carefully to avoid harm and removed safely (Park et al, 2007, p. 13). Four-point restrain is useful in emergency cases when containing a patient with mental disorder and violence. It is recommended after ways of deescalating violent are not sufficient. Proper administration lowers the chances of hurting the patient and healthcare professional while attempting to restrain them. Four point restrain can be given in the inpatient facility or the emergency room. The healthcare professional should make note of the rights of the patient. There are dangerous positions for restraining the patient. For instance, arms or legs should not be locked. Restrain where the face is facing down is discouraged. The techniques cause the patient to experience pain which makes them struggle harder (Ballard and Rockett 2009, p. 3). 2.5. Restraining procedure Restraining a patient requires preparation to avoid incidents or injury. Johnson (2010, p. 182) suggests that, healthcare professional with training should be prepared for emergencies and be willing to assist if required. Before attempting to restrain obtain resources and the required number of people. Get the room ready before the patient is placed in seclusion or exclusion. Ask people by name to give a hand and inform them about the situation. Make a plan on how to approach the patient by assigning specific tasks to everyone. Reach the patient systematically and commit to play own part. Appoint a leader who will give instruction when there is need to change the plan. The leader will assess the situation and make note of the progress. Make an alternative plan incase events do not turn out as expected. The plan will entail a signal that there is success and a signal that there is failure. The leader ill notify the team when efforts are fruitless and they should stop. There should be a clear way of stopping and exiting. Remind the team to avoid chocking or mishandling the assaultive patient. Be prepared to change the physical to chemical restrain if all efforts are not successful to prevent delayed intervention, especially when they continue to struggle after restrain. Do not be deceived by patients who suddenly calm down and comply to all instructions unexpectedly. This could be a sign of tiredness or in the worst case scenario the onset of an illness. Resist from screaming and keep conversations going. Avoid warning healthcare professionals about what the patient might do because this may be taken as an idea by the assaultive patient. 3. Appropriate use of medications as chemical restraints Chemical restraints are used to control behavior by administering medication. The medication is given according to individuals needs. The medication given to violent patients is short- term and is administered depending on the patient’s history and circumstances. It is given on emergency to control behavior and to facilitate treatment (Mohr 2010, p. 5). Other chemical restrains are long- term and adjustments are made when the medicine is given to different patients. The long-term restrain is administered on a regular basis to smooth the progress and management of mental illness and behavioral disorders. After administration of chemical restraint an assessment is done to establish underlying issues such as substance use, anxiety or mental illness (Tardiff, 1999, p. 237). Chemical restraints can be use together with physical restraining techniques. 3.1. Medication categories Chlorpromazine is a medication that has been used to sedate aggressive patients. However, Chlorpromazine’s usefulness has been exceeded by adverse effects on tolerant; hence its use has been discontinued. Butyrophenones have been prescribed as effective and safe medication for use containing violent patients. Butyrophenones have been successfully used together with benzodiazepines to restrain the assaultive behavior. Atypical antipsychotics are also used as chemical restrains as discussed by Halles and Frances (2005, p. 152). 3.1.1. Butyrophenones Dropridol and haloperidol are Butyrophenones, which are also Neuroleptics. Dropridol is appropriate for agitation which causes sedation. Dropridol is a first line medication. Haloperidol is a tranquilizer for calming patients with violence. The medication is given in the form of injection. Dropridol and haloperidol are safe to use for those with substance abuse or overdose, but will require monitoring. Butyrophenones are also known as typical antipsychotics. 3.1.2. Benzodiazepines Benzodiazepines in the form of lorazepam and midazolam can also be used to cause tranquilization effects. Lorazepam is considered the best because it of its short half-life, rapidness, inactive metabolites and effectiveness. Midazolam effects take a shorter time than Lorazepam, but are fast in effect and safe. Benzodiazepines are specifically recommended to patients with intoxication. Other assaultive patients can be given Benzodiazepines for control successfully. 3.1.3. Benzodiazepines and Butyrophenones Combination of Benzodiazepines and Butyrophenones give superior effects than if used alone. One of the successful combinations is haloperidol and lorazepam. Patients respond to combined treatment faster than if given one treatment. Moreover, the side effects are minimal if a combined treatment is administered. 3.2. Atypical antipsychotics Risperidone, ziprasidone and olanzapine are in the category of atypical antipsychotics. The medication is a recent development that corrects the negative effects of extrapyramidal symptoms. The medications have improved outcomes when compared with Butyrophenones. Atypical antipsychotics are tolerable by different groups of patients. The medication is specifically effective on patients with mental disorders in the short-term treatment. 3.3. Effects of chemical restraints Chemical restrains may have effects such as depression of respiration and will require monitoring and proper adherence to policies to ensure safety. Consequently, the chemical restraint is prescribed by the physician. Assessment is made on the patient’s response on vital body organs and body response to the treatment. Healthcare professional should follow the recommended dosage according to the age of the person in crisis. Medication on pregnant and lactating mothers should be avoided. Physical restrain is not recommended for pregnant women because of injury to the spine when in the second and third trimester; hence chemical restrain is recommended. Neuroleptics should not be given to women who are pregnant or nursing. Medication should be discontinued if it causes negative effects (allergy) on the patient. Patients with intoxication should not be given Neuroleptics, since it could cause seizures. Additional, concern emerges since the medication could expose the fetus to abnormalities in development. Pregnant women are likely to get respiratory issues. The fetus could have poor brain growth. Because there is no certainty if the chemical restrain could cause harm to the fetus, it is advisable to use minimal dosage. Conversely, use of Butyrophenones can cause extrapyramidal symptoms which could cause blockage airway leading to mortality. Patients using chemical restraints may have disturbed mental conditions, high blood pressure, rigid muscles and hyperthermia. The conduct of the patient can be disturbed because of sedation. Benzodiazepine causes patients to become sedated, nauseated and confused. Patients who have taken alcohol are at risk of getting respiratory depression if they are given Benzodiazepines (Rund et al, 2006, p. 318). According to Mion (2008, p. 422), healthcare professional should avoid pitfalls that are associated with failure to monitor signs of sedation. Avoid misdiagnosis of agitation and assumption. Healthcare professional should be able to recognize adverse effects of medication in time. 3.4. Administrations of chemical restraints The desired use for the chemical restrains is that it should act very fast and have few side effects. Giving the medication orally is preferred to intramuscular administration. Medication is given using intramuscular means if they fail to cooperate and there is imminent danger. Patients offered oral medication before intramuscular injection tends to trust the healthcare professionals which enable the delivery of efficient service. This is because the patient gins internal form of control as opposed to external control from the healthcare professional. Dissolving formulas and oral concentrated are preferred to the tablets. Tablets are discouraged because patients can hide them in the mouth and fail to swallow. Additionally, tablets take a long time to begin action when compared to dissolving formulas and intramuscular medication. Intravenous is the most preferred because it has the highest score in commencement of action. Therefore, intramuscular or intravenous medication is the most appropriate in emergencies. Tablets are given in the long-term treatment. Obtaining the intramuscular and intravenous medication is more difficult than accessing tablets. Medications administered orally are introduced before the intramuscular and intravenous medication (Rund et al, 2006, p. 321). 3.5. Implications of chemical restrain Legal implications should be considered when a patient is restrained. Different governments have authorized and others illegalized restraining techniques and use of chemical restrain, by implementing policies and giving guidelines. While some may perceive chemical restrain as a medication, other states do not advocate for it because of its side effects. Healthcare professional have to make a judgment before choosing the chemical restrain because the patient has a right and can make a complain. The healthcare professional should investigate the competency of the patient and explain the treatment if they are of sound mind. As a result, the patient can reject or accept medication for restrain if they understand the course of treatment. If the patient is incompetent and poses immediate danger, the healthcare professional can perform chemical restrain. The healthcare professional should allow the patient make a decision to avoid charges of false imprisonment. A restrain free environment is emphasized to prevent the negative effects of restrain. Patients given restrain have been found to suffer injuries from falls, broken bones, impaired circulation, incontinence, social isolation and depression. Some patients have committed suicide with available pieces of cloths and others injured from attempting to escape (Center for Ethics and Human Rights, 2012, p. 2). 4. Conclusion. Restrain is given to prevent harm on patient and others. It enables healthcare professional diagnose, treat and control behavior of patient. Restraining techniques often implemented consist of least restrictive measures, psychological, seclusion and exclusion, mechanical and four-point restraint. The strategies protect the rights of patients and based on individual needs. The restrain is recommended and implemented by healthcare professionals who monitor the progress and give recommendation. Restrain is administered and removed safely by trained healthcare professionals. Regulatory bodies recommend less restraining procedures, time limits and keeping of a record. Chemical restraints are used if other restrain prove futile. Medications that are used include: Benzodiazepines (lorazepam, midazolam), Butyrophenones (dropridol, haloperidol), and atypical antipsychotics (ziprasidone, risperidone, olanzapine). The medications sedate the patient to control behavior. Although the chemical restraints are safe to use, they can cause effects such as depression, hyperthermia, mental conditions, and rigid muscles or affect vital organs; hence the patient should be monitored. Chemical restraints are best administered in the form of dissolving formulas and oral concentrated or intramuscular or intravenous injection. The healthcare professional should be aware of the legal implications to avoid pitfalls. A restrain free environment is suggested since it limits the number of injuries. Reference List Ballard, B. and Rockett, J. (2009). Restraint & Handling for Veterinary Technicians & Assistants. United States: Delmar Cengage Learning. Center for Ethics and Human Rights (2012). Reduction of Patient Restraint and Seclusion in Health Care Settings. Action Report. Halles, R. and Frances, A. (2005) Psychiatry Update: The American Psychiatric Association Annual Review. United States: The American Psychiatric Association. Johnson, M. (2010). Violence and restraint reduction efforts on inpatient psychiatric units. Issues in Mental Health Nursing, 31, 181–187. Lewis, E., and Ford, J. (2000). Hostile Ground: Defusing and Restraining Violent Behavior and Physical Assaults. Paladin Press  Mion, L. (2008). Physical restraint in critical care settings. Geriatric Nursing, 29 (6), 421–423. Mitzel, K., and Votolato, N. (2006). The use of intramuscular benzodiazepines and antipsychotic agents in the treatment of acute agitation or violence in the emergency department. Journal of Emergency Medicine, 31, (3),317-324. Mohr, W. K. (2010). Restraints and the code of ethics: An uneasy fit. Archives of Psychiatric Nursing, 24(1), 3–14. Park, M., Hsiao-Chen Tang, J., Adams, S., & Titler, M. (2007). Evidence-based guideline: Changing the practice of physical restraint use in acute care. Journal of Gerontological Nursing, 33(2), 9–16. Rund, D. A., Ewing, J., Tardiff, K. (1999). Medical Management of the Violent Patient: Clinical Assessment and Therapy (Medical Psychiatry Series). CRC Press. Read More