Presentation on theme: "The Safe Use of Patient Restraints"— Presentation transcript:
1The Safe Use of Patient Restraints Mandatory Annual Review Course
2Click each button for details DefinitionsAny method of physically restricting a person’s freedom of movement, physical activity or normal access to his or her body.Patient immobilization that is a normal component of a procedure is not considered restraint.Restraint is:Medical(Non-behavioral)Restraint:A 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.A drug used solely as a restrictions to manage the patient’s behavior or restrict freedom of movement.Behavioral HealthRestraint:The restriction of patient movement in response to severely aggressive, destructive, violent or suicidal behaviors that place the patient or others in imminent danger.Click each button for further detailsRestraint is not:Forensic restriction used by law enforcement for security purposes.
3Side Rails – Restraint or Not? Click the answerThe use of side rails may pose risk to patient’s safety. Clinical judgment determines whether or not the use of side rails is considered restraints.Raising all four side rails to prevent the patient from exiting the bedNotRestraintRestraintFour or full side rails to prevent the patient from rolling our of bedPatient actively seizingPost-op patient recovering from anesthesiaPatient on a gurneyNotRestraintRestraintClick the photo for examplesNotRestraintRaising fewer than four side rails (when bed has more than two)Restraint
4Alternatives to Restraints Restraints must never be used as a substitute for good nursing care or staff convenience. Restrained patients require MORE CARE and INCREASED DOCUMENTATION.PHYSICAL MEASURESSPIRITUAL NEEDSRelaxation techniquesPromote normal sleep patternsUse of lap belt in chair as a reminderProvide glasses, hearing aid, denturesTape foley to abdomen of male patientUse Activity ApronExercise and activitiesAnticipate and provide for basic needsPSYCHOLOGICAL MEASURESProvide for companionship: family, friendsOrient to realityExplain all proceduresUse TV, radio, musicCollaborate w/other healthcare membersProvide pain medication, eliminate itchContact patient’s pastor, minister, priest, rabbiOffer sacrament of Communion, Reconciliation, Anointing of the SickUse sitter or volunteer to read to patientUse audio tapes, CDsENVIRONMENTAL NEEDS1:1 communicationUse of cushions to maintain safetyLocate patient next to Nurse’s stationUse appropriate lightingUse Geri chair, position commode, walker, near bedsideDecrease noise, control activity levelPlace Call light within reachPosition tubes/drains out of siteInitiate frequent bathroom roundsReview medications for side effects & interactionsPHYSIOLOGICAL MEASURES
5To Determine the NEED for RESTRAINT USE: Patient AssessmentTo Determine the NEED for RESTRAINT USE:Attempt AlternativesUse safe, effective and least restrictive method of restraintClinical Justification based on observed patient actions or behaviorsInterference with therapy or patient carePulling tubesPicking at woundsRemoving dressingsActivity or thoughts with a reasonable probability of harm to selfWanderingUnsteady gait (high risk for falls)SuicidalActivity or thoughts with a reasonable probability of harm to othersConfused patient striking out at othersHomicidal attempt or talks about killing/harming someoneViolent patient in alcohol or drug withdrawal
6Reason for the restraint. Be time specific Include type of restraint. Restraint OrdersRestraints will be initiated or continued on the order of a treating physician. The order must meet the following criteria:Reason for the restraint.Be time specificInclude type of restraint.Reflect least restrictive manner.Be in accordance with safe and appropriate restraining techniques.Be discontinued at the earliest point in time.Never be written as a standing order or PRN.
7Medical vs. Behavior Health Orders Behavioral HealthTime Limitations24 hours4 hours 18yrs or older2 hours 9-17yrs1 hour 8yrs and underRN AssessmentEvery 2 hours or soonerContinuously document every 15 minsMD AssessmentEvery 24 hours prior to writing new orderEvery 8 hours 18yrs or olderEvery 4 hours 17yrs and youngerEmergency Application by RNNotify MD ASAP, within 1 hour MD must provide telephone or written order. MD must assess patient ASAP, within 24 hours.Notify MD ASAP, within 1 hour MD must assess patient and write order.Restraint ReapplicationRequires new order, and MD assessment. -Even if original order has not exceeded its “time limit.” This does not include the temporary release that occurs for patient assessment.
8Observation & Monitoring Assessment will include:The patient’s physical and emotional well-being .Comfort and care needs, including hygiene, elimination, hydration, nutritionThe appropriateness of restraint application, removal, and reapplicationAssessment of the need for continuing or discontinuing restraintPatient death associated with restraint use:RN will immediately notify Nurse Manager or House SupervisorComplete a UOR (unusual occurrence report)Hospitals AR&L Director or designee will notify CMS
9Application of Restraint Must have quick-release applicationUse the correct sizeNote “front” and “back” of deviceSecure to bed springs or frame, not mattress or bed railsDo not apply one-sided restraintsDo not restrain feet while their hands are freePlace call light and necessary items within reachDo not position pregnant patients 20 weeks or greater on their back, nor should chest or waist restraints be usedRestraints should be discontinued as soon as it is no longer indicated by the patient’s actions.
10Patient basic needs must be attended to, including: DocumentationPatient basic needs must be attended to, including:NutritionCirculationRange of motionHygieneEliminationHydrationDocument the following in Patient’s record in KP Health Connect:Physician’s orderInitial assessment by the RN and 1 hour in-person evaluation by MDPatient’s actions or condition that indicated the initial and continued use of restraintLess restrictive alternatives consideredPatient monitoring and response to interventions usedSignificant changes in the patient’s conditionReassessment/observations, discontinuation of restraintsEducation and information about restraints provided to the patient and family
12Quiz Answer True or False Application of restraints should be the initial nursing intervention when caring for the confused or disoriented patient.True FalseRestraints are utilized to prevent disruption of treatment or significant harm to persons.True FalseThe care of a patient in restraints requires more nursing time.True FalseOnce restraints are applied, they are not to be removed by anyone without a physician’s order.True False
13Quiz Answer True or False Bed rails can either be restraints or a protective device, depending on the intent of use.True FalseUse of restraints can be harmful to patients and can result in such outcomes as impaired skin integrity, incontinence, increased falls, etc.True FalseWhen appropriate, the use of alternatives is attempted in an effort to use restraints as a last resort.True FalseReassessment is ongoing and occurs at a minimum of q 4 hours for patients in medical restraints in an effort to discontinue the restraints early whenever possible.True False
14Quiz Answer True or False Four-point soft restraints for an actively suicidal patient requires the same 15-minute observation checks as leather or hard restraints.True FalseA physician’s order for a behavioral health restraint must be time specific with a maximum limit of 4 hours for the adult, 2 hours for children ages 9-17, and 1 hour for children 8 and under.True FalseRNs may discontinue restraints before the ordered time frame, but must obtain a new order if the patient again meets indications that justify restraint.True FalseRNs can apply a restraint without a physician order, but must obtain a verbal phone order within 1 hour of the initiation of the medical restraint.True False
15Select the Correct Answer QuizAnswer True or FalseBed rails should be used on all patient at all times to keep them from falling or getting out of bed.True FalseSelect the Correct AnswerWhich of the following observations intervals is incorrect?Every 30 minutes for a patient in four-point restraints to prevent combative behavior.Every 15 minutes for a patient in leather restraints for violent behavior to prevent injury.Every 2 hours for a patient with soft wrist ties to prevent dislodgment of NG tube.Every 2 hours for bed rails up on a patient to prevent them from continued wandering.
16Select the Correct Answer QuizSelect the Correct AnswerWhich of the following are types of protective devices and not considered restraints?Portable table top chair to prevent the patient from slipping out of the chair.Safety belt on a gurney.Knee immobilizer.All of the above.The nurse should assess and address which of the following at least every two hours for patients who are restrained:Hydration and nutritionHygiene and eliminationContinuance or termination of restraintCirculation and ROMAll of the above.
17Select the Correct Answer QuizSelect the Correct AnswerWhich of the following is not a clinically justified use of restraints?Patient continues to pull at the NG tube after reorientation and explanation.Combative patient in DTs.Patient is 75 years old and is weak and confused.Patient removes abdominal dressing despite use of abdominal binder.Which of the following is not an example of an alternative to restraint use?Medicate patient to induce sleeping.Tape foley to abdomen of male patient.Provide adequate pain medication.Use TV, radio, or music as diversion.
18Select the Correct Answer QuizSelect the Correct AnswerA 9-year-old requires transport via gurney to radiology for a MRI. The gurney rails are placed in the up position. This is not considered restraint because:Children are allowed to sit up in gurneys.The child can see through side rails.Side rails are to be up during patient transports of all types regardless of age and are a protective/safety device.The child will be transferred to an exam table upon arrival so it doesn’t matter.Which of the following employees would need documented competency for restraints?A transportation aide that unties and reties wrist restraints for transport to radiology.A physical therapist that releases and reties a patient restraint in order to exercise a patient.A RN that monitors the patient in restraints.An unlicensed assistant that removes and reapplies restraints to bathe a patient.All of the above.