alternatives to restraints/restraints workshop. definitions what is a restraint? –a restraint can...

Alternatives to Restraints/Restraints

Workshop

Definitions

What is a restraint?– A restraint can either be physical or

chemical and is used to limit activity or to control an individual’s behavior.

Alternatives to Restraint

Patients have the right to control their own body and their actions.

But What Happens When They Become A Risk To Themselves And Others?


The First Step one must consider before physical or chemical restraints are applied / administered depends on:– Is the patient demonstrating disruptive

behavior because they are –Frustrated–Anxious–Bored–Confused


If you can answer “yes” to any of those questions, consider ways to alter or change the patient’s environment.– Walking– Exercise– Reduce noise level to allow the patient to sleep

and to reduce their agitation.– Turn the TV off.– Use bed/chair check– Use family members; get sitters


Why are alternatives to restraints so important?– Patients become weaker with immobilization.– Restraint devices increase agitation.– Patients who are restrained are at a greater risk

of falling and sustaining more serious injuries if they do fall.

– Psychological side effects can include feelings of anger, loss of dignity and depression.

Smith, N., Timms, J., Parker, V., Reimels, E., Hamlin, A. (2003). “The impact of education on the use of physical restrains in the acute care setting.” The Journal of Continuing Education in Nursing. 34(1): 26-33.

What is the difference between…

Acute Medical / Surgical Restraints

&

Behavioral Health Restraints


Medical / Surgical Restraint

Rule of thumb…

If the patient is at risk for interruption of the medical treatment plan, such as pulling out tubes with agitation, he or she meets the criteria for a Medical / Surgical Restraint

Behavioral Health Restraint

Rule of thumb…

A patient who is at risk for imminent harm to either himself or someone else due to violent behavior, he meets the criteria for a Behavioral Health Restraint.

Case Scenario

What category of restraint would be used for this situation…

A female patient returns from surgery and is confused and attempting to pull out her IV and foley catheter. After alternative methods of redirecting her from pulling out her lines have failed, which criteria for restraint would this patient fall under?

Case Scenario

What category of restraint would be used for this situation…

A male patient is admitted with an elevated blood alcohol level. He is admitted to your unit with IV therapy running. He attempts to pull out his line. When you try to redirect him, he verbally threatens you and tries to kick you away from his bed with a purposeful aim, which criteria for restraint would this patient fall under?


Disposable Freedom Splint (alternative to limb holder)

(SDS)

The following products are alternatives to restraints


Self Releasing Lap Hugger (Unit Purchase)



Wedge Foam Cushion(Unit Purchase)


Bedfellow Positioning Roll (Unit Purchase)

cover with a sheet*



Peek a Boo Mitts (SDS)



Types of Restraints

If All Else Fails…

Remember that the care of the patient while he or she is in the restraint is part of a process that requires the health care team to provide quality care. This care is measured by careful documentation!

Types of Restraints– Disposable quick release limb restraint– Side Rails– Locked restraint

Performance Improvement

• Documentation• Patient Care

Safety Concerns

Physicians order must be obtained within one hour of initiation of restraints.

Safety Concerns

Documentation should include:

– The need for restraints– The alternatives that were applied to avoid

restraint usage– Notification of Family– Time the restraint was initiated or

discontinued– The type of restraint in use

Safety Concerns

Documentation should include:

– That observation and patient care needs / assessments were met

– The patient’s behavior while in restraints– Ongoing communication with the patient and

their family concerning the termination of restraint measures

Assessment / Care of the Patient in Restraints

Restraints for Medical Reasons…– Monitor and Observation of Patients every 2 hours.– Observation includes:

• Respiratory Status• Circulation• Signs of Distress• Change in Behavior

– Patient Care every two hours and prn includes:• Comfort measures • Fluid and nutritional needs• Toileting needs• Check circulation of restrained limbs• Range of Motion and Repositioning

– Continue to try alternatives and to eliminate the cause for the use of restraints.

– Reassessment / MD Order daily and prn– Ongoing patient / family teaching related to criteria for removal of

restraints.

Restraints for Behavioral Management…– Patient will be placed on 1:1 observation– Examine Patient and room for contraband– Order a “disposable tray” for patient meals– Modify treatment plans with interventions to eliminate the restraints.– Reassessment under direction of RN every 15 minutes

• Observation and Assessment• Patient Care Assessment and Needs

– Continue to try alternatives to eliminate the cause for the use of the restraints.

– Reassessment for the need for restraints:• By RN every 4 hours ( 2 hours for adolescents)• By MD every 8 hours (4 hours for adolescents)

Assessment / Care of the Patient in Restraints

Questions?

alternatives to restraints/restraints workshop. definitions what is a restraint? –a restraint can...

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