Alternatives to Restraints/Restraints Workshop

1
Alternatives to Restraints/Restraints Workshop
2
Definitions

• What is a restraint?
• A restraint can either be physical or chemical
  and is used to limit activity or to control an
  individuals behavior.

3
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?

4
Alternatives to Restraint

• 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

5
Alternatives to Restraint

• If you can answer yes to any of those
  questions, consider ways to alter or change the
  patients 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

6
Alternatives to Restraint

• 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.

7
Alternatives to Restraint

• What is the difference between
• Acute Medical / Surgical Restraints
• Behavioral Health Restraints

8
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

9
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.

10
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?

11
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?

12
Alternatives to Restraint
The following products are alternatives to
restraints

• Disposable Freedom Splint (alternative to limb
  holder) (SDS)

13
Alternatives to Restraint
The following products are alternatives to
restraints

• Self Releasing Lap Hugger (Unit Purchase)

14
Alternatives to Restraint
The following products are alternatives to
restraints

• Wedge Foam Cushion(Unit Purchase)

15
Alternatives to Restraint
The following products are alternatives to
restraints

• Bedfellow Positioning Roll (Unit Purchase)
• cover with a sheet

16
Alternatives to Restraint
The following products are alternatives to
restraints

• Peek a Boo Mitts (SDS)

17
Types of Restraints

• If All Else FailsRemember 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

18
Performance Improvement

• Documentation
• Patient Care

19
Safety Concerns

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

20
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

21
Safety Concerns

• Documentation should include
• That observation and patient care needs /
  assessments were met
• The patients behavior while in restraints
• Ongoing communication with the patient and their
  family concerning the termination of restraint
  measures

22
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.

23
Assessment / Care of the Patient in Restraints

• Restraints for Behavioral Management
• Patient will be placed on 11 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)

24
Questions?