Previous Page Home PageSearch Engine Index Next Page

Combative-Destructive Precautions

Date of Last Review: 8/1/07
SME: Director of Nursing

All patients have the right to be protected from physical and emotional harm.  Close observation of agitated, violent or potentially violent patients is necessary to preserve this right.

 

Criteria for combative and/or destructive precautions are as follows, but not limited to:

 

1.                  Patient is visibly agitated ex. pacing, clenching fists

 

2.                  Pressured and/or loud speech, argumentative behavior

 

3.                  Threatening others, hostile

 

4.                  Slamming doors, kicking, throwing or hitting objects

 

5.                  History of violence

 

Procedure:

 

An order for precautions is entered by the physician or a registered nurse as an independent nursing intervention, and the physician notified of the patient's condition.  A physician's order must be obtained within 24 hours of the nursing order.  The order must include the precaution reason.  The patient will be provided with a red armband denoting unit restriction until precautions are discontinued.

 

Documentation of the specific behavior necessitating precautions is made in the progress notes.  Thereafter, the RN will document an assessment every shift on the Nursing Flow Sheet/Progress Notes.  The patient is advised when precautions are being implemented and discontinued.

 

Combative/Destructive Precautions require judgment on the part of the caregivers and include but are not limited to:

 

1.                  Assessments of patient mental status and whereabouts.

2.                  Documentation of the assessments every 15 minutes on the Precautions Checklist.

 

All precautions are reviewed daily by the physician and registered nurse. The order will saty active/valid until it is discontinued.

 

Suggested Guidelines:

 

1.      To remain on unit – Unit Restrictions

2.      Observe level of agitation every 15 minutes.  Offer medication as needed.

3.      Offer 1:1 staff talk.

4.      Provide adequate personal space for agitated aggressive, or potentially violent patient.

5.      When possible, place patient in room alone.

6.      Recommend Direct Observation.

7.      Educate or positive Coping Skills

8.      Recommend Anger Management Group

9.      Include in MTP.

Related Standards:

 

 

Previous PageTop Of PageSearch Engine IndexNext Page

If you have questions regarding the content of this site please contact the Policy and Procedure Committee. If you experience any technical problems please contact the MIS Department.

Harris County Psychiatric Center University of Texas Health Science Center