THE USE OF RESTRAINTS AND PHYSICAL THERAPY

By Dymond Unutoa

Objectives

Understand the definitions of Restraint Understand Restraint purposes Recognize Types of Restraints Know possible Alternatives before

Restraining Understand the process of Restrain

Application Recognize Complications with Restraint

use Understand how Physical Therapy can be

Involved Recognize Non-Restraints

Definition of Restraint

1) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely; or

2) A drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition

Purpose

Protection from self and others upon display of violent and unsafe behavior in environment/situation

Care management for a patient who exhibits behavior that is interfering with POC or intervention (i.e. pull on tube/IV)

Use Justification

NON-VIOLENT ORNON-SELF DESTRUCTIVE

VIOLENT/SELF DESTRUCTIVE

Pulling at Invasive Tubes or Lines

Patient safety – Attempts to leave bed when exhibiting disorientated/confused behavior with potential injury to self

Interruption of surgical/wound maintenance (picks at site)

Emergency Behavioral Situation – Physically aggressive with significant potential to harm self or others

Types of Restraint

Sitter Wrist/Ankle Soft Wrist/Ankle Leather Posey Vest Mitt All 4 side rails

engaged Belts

Types Continued

Chemical- Tranquilizers – Decrease agitation in acutely psychotic patients- Benzodiazepines (Valium)- Lorazepam – Elderly, long duration- Midazolam – Rapid sedation, short duration

Considerations

Alternatives Preserving patient rights and dignity Safe application Environment – Their access to

surroundings Patient’s ability to participate in POC Risks associated – Behavior, child,

cognitive

Alternatives to Restraint

Encouragement for family involvement

Patient location in relation to staff

Position of patient bed

Use of Call bell Bed/Exit Alarms Reorient patient to

environment Conceal IV/Tube sites

Application

Assessment for restraint use performed by RN

Physician or LIP that’s authorized to elicit restraint use can do so as per hospital policy

Checked every 15 min Orders in writing Orders must not exceed 24 hrs

Complications

Injury – Abrasions and Bruises*Inappropriate application can lead to serious injury

Pressure sores Circulation disruption Loss of gag reflex - Sedation DEATH

PT Involvement

Collaborate with on-care nurse. Patient education Assessment of potential physiological

outcomes Orientation – Psychological/Cognitive

patients Intervention planning and POC Family education

Non-Restraint Devices

Orthopedically prescribed devises Surgical dressings Bandages Any device that can be manually

removed by patient in same manner as applied.

Thought…

Does knowledge without action become neglect? – Safe Patient Handling

References IASIS Health Care Risk Management Manual. Origination (9/28/08).

Restraint and Seclusion (Section: Clinical Risk Policy Number: RMCO.011)

MedCEU Restraint Continuing Education Course. http://www.medceu.com/index/index.php?page=get_course&courseID=3631&nocheck. Accessed November 17, 2012

Haut A, Kolbe N, Strupeit S, Mayer H, Meyer G. Attitudes of Relative of Nursing Home Residents Toward Physical Restraints. Journal of Nursing Scholarship [serial online]. 2010;42:4,448-456

Williams D. Restraint Safety: an Analysis of Injuries Related to Restraint of People with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities [serial online]. 2009;22:135-139.

Wilson C, Klein A, Kirsch N (Michigan Chapter). Proposal RC 29-12 – The Role of PT in patient handling. Adopted June 2012 in House of Delegates to APTA.

Gulpers M, Bleijlevens M, Ambergen T et al. Belt Restraint Reduction in Nursing Homes: Effects of a Multicomponent Intervention Program. J Am Geriatr Soc [serial online]. 2011;59:2029-2036. Accessed November 19, 2012.