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Presentation on theme: "Restraints."— Presentation transcript:

1 Restraints

2 What are Restraints? Restraints are physical, chemical or environmental measures used to control the physical or behavioural activity of a person or a portion of his/her body.

3 Laws Policies of the Ministry of Health and Long-Term Care that are binding on long-term-care facilities Statutes and regulations of Ontario that govern the use of restraints in facilities (the Charitable Institutions Act, the Nursing Home Act, the Homes for the Aged and Rest Homes Act) The common law, which includes among various civil wrongs the torts of battery, assault and false imprisonment The Criminal Code of Canada, which includes criminal offences. The Canadian Constitution, which includes the Canadian Charter of Rights and Freedoms.

4 Risks of Restraints Falls Strangulation Loss of Muscle tone
Pressure sores Decreased mobility Agitation Reduced bone mass Stiffness Frustration Loss of Dignity Incontinence Constipation

5 Risk without Restraints
Falls Safety of self and others

6 Kensington Gardens Policy
The Home practices a philosophy of Least Restraint.

7 Who? What? Why? How? When? Least restraint means all possible alternative interventions are exhausted before deciding to use a restraint. This requires assessment and analysis of what is causing the behaviour. All behaviour has meaning. When the reason for the behaviour is identified, interventions can be planned to resolve whatever difficulty the resident is having that contributes to the consideration of restraint use.

8 Kensington Gardens Policy
Restraint Assessment Form must be completed prior to initial application of the restraint.

9 Assessment Tools Behavioural Map Aggressive Behaviour Risk Assessment
Behavioural Map Aggressive Behaviour Risk Assessment   Cohen-Mansfield Agitation Inventory   Continence Assessment TENA incontinence product evaluation  

10 Environmental Improved or altered lighting
Path cleared in resident's room/on unit     Cloth barrier across doorway     Comfortable room temperature     Privacy and dignity     Environment personalized     Wanderguard applied    Moved to secure unit     Night light    

11 Safety Positioning of pillows Bed height lowered
Call bell within easy reach Bed, Chair or Seatbelt Alarm   Side rails     Floor pad beside bed   

12 Toileting and Continence
Individualized toileting routine     Product change     Identify bathroom using signs/symbols     Commode at bedside     Urinal at bedside    

13 Direct Care One to one supervision/support
Medical conditions, i.e. infections     Individualized daily routine     Move resident closer to RHA Infomation Centre     Facilitate rest periods     Limit time spent in bed     

14 Direct Care Continued Apply glasses and/or hearing aides
Use ambulatory aides as per Care Plan     Evaluate medical interventions i.e. catheter, feeding tube     Provide cues during care/activities

15 Physiological Interventions
Treatment of the underlying pathology, i.e. medication ordered     Pain management     Medication review    

16 Psychological Companionship Active listening
Increase family/friends visiting     Consistent staffing     Encourage staff one to one activities     Familiarization with the environment     Behaviour management intervention     Alter sensory stimulation      Remove to a quiet area     Relaxation techniques     

17 Life Enhancement & Programs
Teach safe transfer techniques to resident/family/responsible party     Walking and exercise programs     Incorporate exercise into daily plan of care     Meaningful individual and/or group activities     Music therapy     PT/OT consult    

18 Nutritional Care Provide adequate fluid/nutritional intake
Adapt provision of nutrition to resident's condition, i.e. finger food, frequent small meals, etc.     Dietitian Consult    

19 Referrals Attending Physician Social Worker Psycho-Geriatric Team
Gerontologist     External Therapeutic Assessment Program i.e. Toronto Rehab  

20 Seating and Positioning
High back or supportive chair  Individualized seating    Chair tilt mechanism    

21 Positioning in a Wheelchair
Hips Level and positioned at the back of the seat Upper Legs Supported on the cushion to three (3) inches behind the knee Feet Resting on the footrests Back Against the back of the cushion

22 Positioning in a Wheelchair
Headrest Must be on wheelchair and positioned when chair is tilted Use of tilt Change tilt position many times throughout the day Padded Leg Slings Loose to allow legs to rest back when in tilt

23 Things that Interfere with Good Positioning
Cushion Check- air amount, gel quality, wrong way, upside down, pommel Medical- hip flexion restriction, back pain back kyphosis, scoliosis Pads and transfer slings on top of cushion

24 Improper Positioning Falls to the side or forward
Slides out of the wheelchair Redness on pressure areas Discomfort Unable to self propel with hands or feet Unable to engage in functional activity

25 Pressure Areas

26 Seating Cushion Materials
Foams- Pommel at the front of the cushion Fluid Gels- Must be kneaded properly after each use Roho Cushion- Ensure right amount of air

27 Roho Cushion Correct amount: the cushion looks ¾ full
When pressure is placed on the cushion, then released, the cushion regains its shape Too Much Air: All cells are visible, the cushion is hard, unstable and looks too large for the wheelchair

28 Restraint Deemed Necessary
The Least Restrictive is Used

29 Consent Documentation shows thorough assessment of the need for a restraint, including ALL alternate measures attempted The decision to apply a restraint involves the resident and/or his family/substitute decision-maker.

30 Doctor’s Order Restraint is applied on written order (or a telephone order which is cosigned) of a Physician who has attended the resident and approved the type of restraint.

31 Approved Restraints Wheelchair tray Rear facing seatbelts
Lap restraint Mitt restraint Self limiting seat belt (resident cannot undo without assistance)

32 How Often do I check? The resident is checked at a minimum of hourly and repositioned at a minimum of every two hours while restrained.

33 Documentation Document on the Restraint Monitoring Record.

34 Proper Application of Seatbelts

35 Compare to a Car Seatbelt
CHECK THAT THE SEAT BELT IS TIGHTENED APPROPRIATELY Place one flat hand between belt and resident Too Loose is Dangerous Position at the hips not the abdomen

36 NO Twisting Ensure the belt is not twisted
Do not tie belt around arm of chair If seatbelt is too long inform Shopper’s Home Health

37 Reassessment The need for continuing use of the restraint is reassessed within 12 hours and the Restraint Monitoring record signed at the bottom by the Registered staff to indicate the continued need past twelve hours Registered staff are also required to reassess restraint quarterly

38 Questions?

39 The End!!! Thank-you for Coming

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