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Physical Restraint Reduction for Older Adults. Objectives Define physical restraint and describe the characteristics of restraint use. Define physical.

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Presentation on theme: "Physical Restraint Reduction for Older Adults. Objectives Define physical restraint and describe the characteristics of restraint use. Define physical."— Presentation transcript:

1 Physical Restraint Reduction for Older Adults

2 Objectives Define physical restraint and describe the characteristics of restraint use. Define physical restraint and describe the characteristics of restraint use. Identify the older adults most at risk of being physically restrained. Identify the older adults most at risk of being physically restrained. Discuss myths and facts about physical restraint use. Discuss myths and facts about physical restraint use. Discuss the reasons most frequently given by health professionals for using physical restraint. Discuss the reasons most frequently given by health professionals for using physical restraint.

3 Objectives Describe morbidity and mortality risks associated with physical restraint. Describe morbidity and mortality risks associated with physical restraint. Plan the nursing care of older adults, using restraint-free strategies. Plan the nursing care of older adults, using restraint-free strategies. Explain alternatives to the use of physical restraints. Explain alternatives to the use of physical restraints.

4 Definitions Physical Restraint Any manual method or physical or mechanical device, material or equipment attached or adjacent to the person’s body that he cannot remove easily which restricts freedom of movement or normal access to one’s body.

5 Definitions Medical Immobilization Medical Immobilization Temporary Temporary Performance of and recovery from medical surgical treatment Performance of and recovery from medical surgical treatment Surgical positioning Surgical positioning IV arm boards IV arm boards Bulky dressing Bulky dressing Forensic Restraint Forensic Restraint

6 Types of restraints Soft wrist/ankle Soft wrist/ankle Straps/belts Straps/belts Two- three- or four-point Two- three- or four-point Wheelchair safety bars Wheelchair safety bars Mitt Mitt Chairs with lapboards Chairs with lapboards Beds with siderails Beds with siderails Bedsheets Bedsheets Vest/jacket Vest/jacket

7 Restraint Use for Older Adults Nursing home residents = 15% Nursing home residents = 15% Acute care settings = 6% to 17% Acute care settings = 6% to 17%Incidence 65+ population = 18% to 20% 65+ population = 18% to 20% 75+ and older = up to 22% 75+ and older = up to 22% Depression, agitation, confusion, withdrawal, anger = 20% to 50% Depression, agitation, confusion, withdrawal, anger = 20% to 50%

8 Who are at risk for restraints? Unsteady mobility or history of falling Unsteady mobility or history of falling Increased severity of illness Increased severity of illness Multiple debilitating conditions Multiple debilitating conditions Cognitive impairment Cognitive impairment Psychiatric conditions Psychiatric conditions Recent surgical procedure Recent surgical procedure Medical devices Medical devices

9 Myths and Facts Myths and Facts “The old should be restrained because they are more likely to fall and seriously injure themselves.” “The old should be restrained because they are more likely to fall and seriously injure themselves.” “The moral duty to protect from harm requires restraint.” “The moral duty to protect from harm requires restraint.” It doesn’t really bother older people to be restrained.” It doesn’t really bother older people to be restrained.” “We have to restrain because of inadequate staffing.” “We have to restrain because of inadequate staffing.”

10 Reasons for using restraints Prevent falls and protect the patient from harm Prevent falls and protect the patient from harm Prevent interference with medical treatments Prevent interference with medical treatments Protect medical devices Protect medical devices Decrease legal liability and family pressure Decrease legal liability and family pressure Control disruptive behavior Control disruptive behavior

11 Morbidity and Mortality Risks Short Term Complications Hyperthermia Hyperthermia New-onset bowel and bladder incontinence; constipation New-onset bowel and bladder incontinence; constipation Decreased appetite Decreased appetite Pressure ulcers Pressure ulcers Muscle weakness Muscle weakness Injury to nerve and joints Injury to nerve and joints Increased risk of nosocomial infection Increased risk of nosocomial infection Pneumonia and respiratory complications Pneumonia and respiratory complications

12 Severe or Permanent Injuries Spiraling immobility Spiraling immobility Risk for strangulation Risk for strangulation Hypoxic encephalopathy Hypoxic encephalopathy Deconditioning Deconditioning Death from strangulation Death from strangulation Psychological Effects: anger, aggressiveness, humiliation, demoralization, depression, low self- worth, social isolation Psychological Effects: anger, aggressiveness, humiliation, demoralization, depression, low self- worth, social isolation

13 Restraint Research “Perception of Restraint Use Questionnaire” (PRUQ)- revised 1998 “Perception of Restraint Use Questionnaire” (PRUQ)- revised 1998 “Subjective Experience of Being Restrained” (SEBR) “Subjective Experience of Being Restrained” (SEBR)

14 Available at: hcgne/H_tools.htm hcgne/H_tools.htm Hartford Center of Geriatric Nursing Excellence University of Pennsylvania School of Nursing

15 Available at: hcgne/H_tools.htm hcgne/H_tools.htm Hartford Center of Geriatric Nursing Excellence University of Pennsylvania School of Nursing

16 Restraint-free guidelines Establish restraint-free standard Establish restraint-free standard Least restrictive but safest environment Least restrictive but safest environment Clinically appropriate situations; not “routine”; evaluate patient Clinically appropriate situations; not “routine”; evaluate patient Rationale must be documented; orders limited in duration to 24-hours. Rationale must be documented; orders limited in duration to 24-hours.

17 Restraint-free guidelines Monitor for complication every 4 hours and more frequently Monitor for complication every 4 hours and more frequently Educate patient and significant others Educate patient and significant others Medicate to mitigate need for restraints Medicate to mitigate need for restraints Consider weaning and early extubation Consider weaning and early extubation Use adaptive equipment for impaired mobility Use adaptive equipment for impaired mobility Institute fall prevention strategies Institute fall prevention strategies

18 Restraint-free guidelines Behavioral management strategies Behavioral management strategies Modify medical devices Modify medical devices Include family / surrogates Include family / surrogates Become familiar with statistics and institutional guidelines, policies and procedures; evaluate compliance at unit and institutional level Become familiar with statistics and institutional guidelines, policies and procedures; evaluate compliance at unit and institutional level

19 Alternative to restraints Pharmacologic agents (NOT CHEMICAL RESTRAINT) to treat patient’s agitation Pharmacologic agents (NOT CHEMICAL RESTRAINT) to treat patient’s agitation Early identification of source of patient’s discomfort and agitation Early identification of source of patient’s discomfort and agitation Increase patient observations - video cameras, move closer to nurses station Increase patient observations - video cameras, move closer to nurses station Music and frequent reorientation Music and frequent reorientation Allow family greater access; visit audiotapes of family Allow family greater access; visit audiotapes of family

20 Alternatives to restraints Alter the environment Reduce noise level Reduce noise level Turn TV off Turn TV off Use bed exit alarms Use bed exit alarms Relocate patient near the nurse’s station Relocate patient near the nurse’s station Use family members and sitters Use family members and sitters Lower nurse-to-patient ratio Lower nurse-to-patient ratio

21 SUMMARY Defined physical restraint, medical immobilization, and forensic restraint Defined physical restraint, medical immobilization, and forensic restraint Types of restraints Types of restraints Who are at risk for being restrained Who are at risk for being restrained Myths and facts Myths and facts Reasons for restraining patients Reasons for restraining patients Morbidity and mortality Morbidity and mortality Guidelines and strategies in promoting a restraint-free environment Guidelines and strategies in promoting a restraint-free environment


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