1. Menu 2012 Restraints Module for LIPs

2. Huntington Hospital CBL Menu Restraints are limited to those situations where there is appropriate clinical justification Restraints will be selected when alternative interventions have been attempted and determined to be ineffective to protect the patient and/or others from harm The staff will employ the least restrictive method of physical restraint for the shortest possible duration Restraints will be used for medical necessity only and not as a means of coercion, discipline, convenience, or retaliation Residents are permitted to order restraints once education has been completed under the rules of the GME program Hospital Philosophy on Restraint Use

3. Huntington Hospital CBL Menu Definition of Restraint Physical Restraint –Any manual method or physical or mechanical device, material or equipment Attached or adjacent to the patient’s body That he or she cannot easily remove That restricts freedom of movement or normal access to patient’s body –Includes use of side rails intended to prevent patient exit from the bed Chemical Restraint –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 patients condition.

4. Huntington Hospital CBL Menu Definition of Seclusion Seclusion –Is the involuntary confinement of a person in a room or an area where the person is physically prevented from leaving –May only be used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member or others. only Is only used in DMC and ER

5. Huntington Hospital CBL Menu Restraint Categories Type of category is determined by the SITUATION that the restraint is being used to address NOT the diagnosis or treatment setting Non-Violent/Non-Self-Destructive –Used to promote medical/surgical healing (removing tubes, lines or wandering) –Non-violent and non-self-destructive Violent/Self-Destructive –Emergency measure –Violent and/or self-destructive behavior that jeopardizes the immediate physical safety of the patient, staff or others.

6. Huntington Hospital CBL Menu Non Violent/ Non-self-destructive Violent/self-destructive No standing or prn orders Must be on Restraint Order Sheet Orders

7. Huntington Hospital CBL Menu Non Violent/ Non-Self-Destructive Restraints Initiation –RN will notify LIP and obtain written/telephone order Within 12 hours of initiation Immediately, if based on significant change in patient’s condition –LIP will sign order based on physical exam on Restraint Order Form within 24 hours of restraint initiation Continuation –A new Restraint Order Sheet must be completed at least every 24 hours (cannot exceed 24 hours) AND is based upon an examination of the patient by the LIP.

8. Huntington Hospital CBL Menu Key Point Restraints for behavior that appears violent or self-destructive that is triggered by a medical condition still fall under the category of “Non- Violent/Non-Self-Destructive” restraints.

9. Huntington Hospital CBL Menu Restraint for Violent/Self-Destructive Behavior A face to face evaluation must occur in 1 hour –For inpatients, the DMC RN supervisor may perform this evaluation instead of the LIP A new order is required more frequently Time limits for orders based on age –Four hours for 18 years of age and older. –Two hours for ages 9-17 –One hour age 9 and younger

10. Huntington Hospital CBL Menu Restraint for Violent/Self-Destructive Behavior Continuation Alternating RN telephone order from LIP/Physician and face-to-face LIP evaluation. –If V/SD Restraints are still required for an adult patient after 4 hours, the RN can get a telephone order. –If they are still required 4 hours later (the patient has now been in restraints for 8 hours), the LIP/Physician must now come in to perform the face-to-face evaluation. –It should be VERY unusual to have V/SD restraints in adult or pediatric units for this length of time.

11. Huntington Hospital CBL Menu Discontinuation of Restraints Restraints will be removed when: –Reason for restraint is no longer present –Alternative strategies become successful –Reassessment indicates reason for use of restraint no longer applies –Upon physician order

12. Huntington Hospital CBL Menu Reapplication of Restraints If the restraint is discontinued prior to expiration of the original order, and re-initiation of restraint is indicated, a new order must be obtained and the standards restarted.

13. Huntington Hospital CBL Menu Key Points & Summary Remember, restraints DO NOT PREVENT FALLS or pulling on tubes or medical devices Always try least restrictive methods before actual restraints are employed. The Order Set must be used –The Order Sets contain the required elements of documentation for the LIP

14. Huntington Hospital CBL Menu Thank You We hope this computer-based learning course has been both informative and helpful Click the Take Test button on the left side when you are ready to complete the requirements for this course. A passing score is 90%. Click on the My Records button to return to your CBL Courses to Complete list Click the Exit button on the left to close the Student Interface