Definition of Seclusion

Transcription

1 Definition of Seclusion The involuntary confinement of a patient ALONE in a room or area from which the patient is physically prevented from leaving This now must be ordered for patients confined to a room by a one to one, unless for suicide observation.

2 Definition of Chemical Restraints Medications are Chemical Restraints when They are used as a restriction to manage the patient s freedom of movement and is NOT a standard treatment or dosage for the patient s condition

3 When is a Restraint Appropriate? To ensure the immediate physical safety of the patient, a staff member or others When less restrictive interventions have been determined to be ineffective to protect the patient, staff member or other from harm in accordance with a written modification to the patient s plan of care when the type or technique is the least restrictive intervention that will be effective to protect the patient or others from harm in accordance with safe and appropriate restraint techniques as determined by the hospital policy

4 Involving family When appropriate, discuss with family when restraints are or maybe needed Invite their ideas for ways the prevent the need for restraints

5 Med Surg Safety Restraint Orders obtain the order BEFORE applying a restraint orders must be written prior to the restraint and Q 24hrs Monitoring Q2hrs when used in NON-Violent/Non Self-destructive patients Nutrition Elimination Repositioning Device removal Hydration Hygiene Comfort Circulation

6 Behavioral Restraints Orders For Violent Patients: Restraints can be initiated prior to getting an order ONLY when there is a clear and immediate danger to a patient or staff. (as in the case of a violent/self destructive patient) An order must be obtained as soon as possible and a face to face evaluation of the patient must occur within 1 hour For Violent /Self Destructive Patients: The Licensed independent practitioner MUST see the patient within 1 hour to: Evaluation the immediate situation Patients reaction to the intervention Evaluation their medical and behavioral condition Determine the need to continue or terminate the restraint

7 Behavioral Restraints The order is good for only 4 hours for an adult, 2 hours for ages 9-17 and 1 hour for under the age of 9 There must be a FACE to FACE reevaluation of the patient at least every 8 hours Q15min for Violent/Self Destructive patients Signs of injury Nutrition Hydration Circulation ROM Hygiene Elimination By Observation worker The nurse must assess the patient as often as necessary but the above assessments, the patients physical and psychological status, and readiness for discontinuation of restraints must be made Q1hr

8 Restraint Orders May be ordered by a licensed independent practitioner who is responsible for the patient s care The attending physician must be consulted as soon as possible if they did not write the order Restraints can be initiated (before receiving an order (as determined by hospital policy) when there is a clear danger and immediate risk of harm to the patient or staff member PRN or standing orders for restraints ARE NOT permitted

9 Importance of vital signs with restraints Heart rate: is the heart rate > 100? This can show an added stress on the heart, can be a sign of fear and agitation Respiratory rate: is the respiratory rate> 28? This can be a sign of anxiety, panic, or could be caused by tightness of the restraint around the chest or neck. Blood pressure: Is the blood pressure more than 15 points higher than the persons baseline?? BP can rise with agitation and fear

10 Signs of distress while in restraints Edema of the extremity: Check for a pulse, color, sensation and motion of the extremity restrained. If edema is restraint related, remove/loosen restraint, if no pulse or change in CSM, notify MD Discolor of the extremity: Either paleness or a blue discoloration of the extremity must be reported Change in sensation of the extremity: Can the person feel you touch the restrained extremity Change in movement of the extremity: Can the patient move their fingers and toes

11 Signs of distress while in restraints Difficulty breathing: Ensure restraint is not restricting the patient anyway between the neck to the hips Assist patient to an upright position, check 02 sat Skin irritation: Check the skin under the restraint, if redness or skin tear noted, loosen restraint, consider padding the restraint with ABD pads, if skin broken, consult skin care nurse Bleeding: If a patient begins to bleed, while wearing gloves apply pressure to the bleeding area and elevate it. Choking: Monitor patients ability to cough and clear their lungs. If unable to speak, perform Heimlich maneuver Pain: Notify the nurse of any complaints of pain. Patients fighting in restraints can injure joints and muscles

12 Signs of Distress while in Restraints: Psychological Increased anxiety: pressured and rapid speech. Restlessness and agitation Anger Frustration Misunderstanding the rationale for the restraint as something other than a safety measure Despondent Non communicative Depressed Post traumatic stress disorder

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15 When is it time to remove the restraint? Patient demonstrates calm behavior and is able to listen to and follow instructions The behavior that stimulated the use of the restraint is no longer demonstrated Patient is able to contract with staff that they will not harm themselves or others if restraint removed The device we were trying to protect the patient from harming for their medical-surgical healing is no longer needed

16 Mental Health Patients Refers to a patient whose primary need for care is psychological in nature Restraints requires an MD order which must take place within 1 hour of the restraint and is validate for 3 hours The patient must be evaluated by the MD within 1 hour of the restraint and every 6 hours as long as the restraint is in use After 3 hours, the nurse can take a verbal order to renew the order for another 3 hours Use the DMH forms: # 1 MD order # 2 Monitoring form # 3 Patient comment form There is also a team debriefing form

17 Rationale Alternatives tried MD order

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20 Update the Patient s Plan of Care Individualize the Safety Risk problem with either the Extubation Fall Wandering or Agitation Protocols

21 When the worse happens. If the patient aspirates: assist the patient to an upright position monitor their ability to cough and clear lungs, if unable to clear lungs; consider suctioning. If unable to cough or speak, utilize the Heimlich manuever If the patient becomes unresponsive and pulseless while in restraints, remove the restraints (noting their position at the time of arrest) implement BLS measures: Airway, Breathing, Circulation Complete an incident report in RL. If the patient dies, call Quality and Safety as well as this is a reportable death

22 Death Reporting The practitioner will report to the Department of Quality and Safety any patient death that occurs: During a restraint or seclusion episode within 24hrs after removal from restraint or seclusion Within one week after a restraint or seclusion where it is reasonable to assume that the use of restraint or seclusion directly or indirectly contributed to a death When a member of Quality and Safety notifies CMS of the death, they will document the date and time of the call in the medical record