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Your Truth: Chemical vs. Physical Restraints

Posted Oct 03 2008 11:31am 1 Comment
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?
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The FDA has issued a black box warning against the use of antipsychotic meds for "chemical restraint" in cases of dementia psychosis.  In fact, there are NO recommended meds for this problem.  What's more, there are numerous examples and studies of patients with dementia dying as a result of using chemical restraints.  The research is established that the use of antipsychotic medications in dementia patients hastens their demise and on average shortens their life by at least six months.  The recommendation from the FDA and from the medical community at present is to use alternative management; i.e., to have staff that is properly trained at managing "difficult" behaviors using methods other than drugs or physical restraints.
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