2What 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.
3LawsPolicies of the Ministry of Health and Long-Term Care that are binding on long-term-care facilitiesStatutes 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 imprisonmentThe Criminal Code of Canada, which includes criminal offences.The Canadian Constitution, which includes the Canadian Charter of Rights and Freedoms.
4Risks of Restraints Falls Strangulation Loss of Muscle tone Pressure soresDecreased mobilityAgitationReduced bone massStiffnessFrustrationLoss of DignityIncontinenceConstipation
5Risk without Restraints FallsSafety of self and others
6Kensington Gardens Policy The Homepractices aphilosophy ofLeastRestraint.
7Who? 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.
8Kensington Gardens Policy Restraint Assessment Form must be completed prior to initial application of the restraint.
10Environmental 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
11Safety Positioning of pillows Bed height lowered Call bell within easy reachBed, Chair or Seatbelt Alarm Side rails Floor pad beside bed
12Toileting and Continence Individualized toileting routine Product change Identify bathroom using signs/symbols Commode at bedside Urinal at bedside
13Direct 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
14Direct 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
15Physiological Interventions Treatment of the underlying pathology, i.e. medication ordered Pain management Medication review
16Psychological 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
17Life 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
18Nutritional Care Provide adequate fluid/nutritional intake Adapt provision of nutrition to resident's condition, i.e. finger food, frequent small meals, etc. Dietitian Consult
19Referrals Attending Physician Social Worker Psycho-Geriatric Team Gerontologist External Therapeutic Assessment Program i.e. Toronto Rehab
20Seating and Positioning High back or supportive chair Individualized seating Chair tilt mechanism
21Positioning in a Wheelchair HipsLevel and positioned at the back of the seatUpper LegsSupported on the cushion to three (3) inches behind the kneeFeetResting on the footrestsBackAgainst the back of the cushion
22Positioning in a Wheelchair HeadrestMust be on wheelchair and positioned when chair is tiltedUse of tiltChange tilt position many times throughout the dayPadded Leg SlingsLoose to allow legs to rest back when in tilt
23Things that Interfere with Good Positioning Cushion Check- air amount, gel quality, wrong way, upside down, pommelMedical- hip flexion restriction, back pain back kyphosis, scoliosisPads and transfer slings on top of cushion
24Improper Positioning Falls to the side or forward Slides out of the wheelchairRedness on pressure areasDiscomfortUnable to self propel with hands or feetUnable to engage in functional activity
26Seating Cushion Materials Foams- Pommel at the front of the cushionFluid Gels- Must be kneaded properly after each useRoho Cushion- Ensure right amount of air
27Roho Cushion Correct amount: the cushion looks ¾ full When pressure is placed on the cushion, then released, the cushion regains its shapeToo Much Air: All cells are visible, the cushion is hard, unstable and looks too large for the wheelchair
28Restraint Deemed Necessary The Least Restrictive is Used
29ConsentDocumentation shows thorough assessment of the need for a restraint, including ALL alternate measures attemptedThe decision to apply a restraint involves the resident and/or his family/substitute decision-maker.
30Doctor’s OrderRestraint 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.
31Approved Restraints Wheelchair tray Rear facing seatbelts Lap restraintMitt restraintSelf limiting seat belt (resident cannot undo without assistance)
32How Often do I check?The resident is checked at a minimum of hourly and repositioned at a minimum of every two hours while restrained.
33DocumentationDocument on the Restraint Monitoring Record.
34Proper Application of Seatbelts ONLY FASTEN THE SEAT BELT IF & WHEN REQUIREDMAKE SURE THE SEAT BELT IS IN GOOD CONDITION
35Compare to a Car Seatbelt CHECK THAT THE SEAT BELT IS TIGHTENED APPROPRIATELYPlace one flat hand between belt and residentToo Loose is DangerousPosition at the hips not the abdomen
36NO Twisting Ensure the belt is not twisted Do not tie belt around arm of chairIf seatbelt is too long inform Shopper’s Home Health
37ReassessmentThe 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 hoursRegistered staff are also required to reassess restraint quarterly