Restraint Reduction. Moving Towards Restraint Free Care
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1 Restraint Reduction Moving Towards Restraint Free Care Revised: BW/September 2010
2 RESTRAINTS: Defined Any manual method, physical or mechanical device, material or equipment, that immobilizes or reduces the ability of the patient to move his or her arms, legs, body, or head freely; A drug or medication which is used as a restriction to manage the patient s behavior or to restrict the patient s freedom of movement and is not a standard treatment or dosage for the patient s condition. Verbal language that will impose upon decision making abilities, actively persuade, encourage, or discourage a patient s actions, threaten, or instill fear.
3 RESTRAINTS: Do Not Include Handcuffs or other restrictive devices applied by law enforcement officials for custody/detention purposes Devices used to limit mobility in relation to medical, dental, diagnostic, or surgical procedures and the related postprocedure care processes. Protective helmets Surgical dressings or bandages. Side rails: Raised for seizure precautions Raised on stretchers Four (4) side rails raised on specialty beds up in rotating modes used for pulmonary toileting in the critical care units.
4 RESTRAINT: Non-Violent Behavior Used for the following: To improve the patient s well-being and safety. To directly support medical healing. When behavior is irrational or uncooperative, attempting to seriously interfere with physical medical treatment or device: IV, ventilator, dressings, tubes, drains, etc. When less restrictive measures have proven ineffective.
5 RN Responsibilities Assess the patient Attempt alternatives Obtain physician order Monitor patient per Patient Monitoring Criteria Coordinate patient care based on monitoring criteria. Reassess patient s need for restraint (reorder required q24h) Notification of nursing leadership when patient is in restraints for =/> 3 days.
6 Before Applying Restraints, Ask Yourself If You Have.. Used creative strategies such Increased staff or family as: supervision Concealing the g-tube with Moved the patient to a an abdominal binder? room closer to nurses station Concealing the IV tubing Sat the patient in a chair with long clothing or a near the nurses station gown? Scheduled frequent Concealing catheter tubing patient rounds with pajama bottoms? Suggested a physical therapy consult Tried an ambulation and toileting schedule
7 Assessment and Management of Underlying Physical Problems Incontinence, fecal impaction, constipation, UTI, full bladder Pain Hunger or thirst Sensory impairment (vision, hearing) Dementia, delirium, psychosis Cognitive defects Muscle weakness Alcohol withdrawal Electrolyte Imbalance Assessing the patient thoroughly is the first step in limiting the use of restraints.
8 Review of Medication Regime Side effects of medication Complications of polypharmacy Dosing with awareness of patient s age or compromised physical status Scheduling of medications Encourage initiation of oral medications, as opposed to IV, when possible Are PRN meds available and are they being used? Have meds from Long Term Care Facility been continued?
9 Interventions Environmental Lower beds of patients at risk Improve lighting Keep a clear path to the bathroom and door Keep call bell and personal items within reach Answer call bells promptly Behavior Management Structured routine Relaxation techniques (therapeutic touch, massage, warm baths music therapy) Psychiatric consult Verbal Use distraction and diversion to change the focus of the behavior Reorient as necessary Use simple language when giving directions
10 Patient and Family Education Educating patients and families can help reduce, or eliminate, the need for restraints. Whenever possible or appropriate: Explain why a restraint may be necessary Explain the possible benefits and risks of restraints Discuss available alternatives Ask for suggestions or help
11 Remember Early identification of potential behavioral and environmental risk factors, as well as useful alternatives, are part of routine assessment and allow for planning for, rather than reacting to, these patient situations. When Restraints Must Be Used: the patient s rights, dignity and well-being must be protected and maintained. Preventive strategies must be tried AND DOCUMENTED before using restraints.
12 Restraint for Violent/Self Destructive Behavior Behavioral restraints are used to protect the patient from: Injury or harm to self Injury or harm to others Destruction of the environment
13 RN Responsibilities Assess the patient Attempt alternatives Emergency situations: the RN can restrain the patient but must: Obtain order within one (1) hour of applying restraint Face to face evaluation by MD within one (1) hour of initiating restraint Reassessment of the need and monitoring/care of the patient as outlined in Monitoring Criteria table.
14 Reordering Restraints (Violent/Self Destructive Behavior Adults (18 years and older) Reorder every 4 hours Reevaluation by MD in person every 8 hours Adolescents (age 9-17 years) Reorder every 2 hours Reevaluation by MD in person every 4 hours Children (Under age 9) Reorder every hour Reevaluation by MD in person every 4 hours
Restraint Reduction. Moving Towards Restraint Free Care
Restraint Reduction Moving Towards Restraint Free Care Revised: BW/January 2016 RESTRAINTS: Defined Any manual method, physical or mechanical device, material or equipment, that immobilizes or reduces
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