1. Farhiyo hassan Zabiti Omer
Restraints
Farhiyo hassan
Zabiti Omer

2. Restraints Purpose Interdiction Staff Education
Legal Implications of using Restraints
Staff Education
Stander Use of Restraints
Nursing managments/Observation
Complications
Chemical Restraints
Precautions

3. Purpose To limit the use of restraints for non-behavior purpose.
To provide guidelines for the use of restraints in patient care and define documentation requirements.

4. What is restraints?
Restraints are any physical or pharmacological means to restrict a patient’s movement, activity, or access to their body. Patients have a right to be free from restraints unless restraint is necessary to treat their medical symptoms or to prevent patient from harming themselves or others.

5. Legal Implications of using Restraints
Federal and local laws have been passed that protect the patient from physical, mental abuse and from physical and chemical restraints except those that are authorized by physician in writing, for specified and limited period of time or that needed in an emergencies situation.
The devices must be applied by licensed, qualified personnel include physician’s assistants or nursing practitioners. Incase of emergencies situations clinical nurse manager may initiate before obtaining the written order.
Never use restraints for discipline or staff convenience.

6. Cont…
Writing Orders for restraints should include the time limitation, start and end time, type of restraint, in frequency of monitoring and reevaluation.
Time limitations should not exceed 24 hours.
If the patient is restrained because of behavioral, the should not exceed 4 hours for adults, 2 hours for children aged years, and 1 hour for children younger than 9 years.

7. Staff Education
Teaching for care providers will be included in orientation and repeated as a necessary if problems are indentified through management. Teaching will be based on activities and responsibilities related to restraints use, which include:
Use of restraint alternative
Hospital policy
Less restrictive measures
Type of restraint and safe abdication

8. Con… Body alignment and positioning
Patient comfort, modesty, right and respect
Patient and Family education
Patient monitoring/observation and reassessment: AV, signs of injury associated with application, skin integrity, circulation, and range of motion.

9. Stander Use Of Restraints
Temporary procedure or medical immunization is normally used during medical diagnostic or surgical procedures such as test, surgery, a circumcision or therapeutic holding.
Individual patients needs are assessed for postural support to balance for specific physical deficit and to promote maximum normative bodily functioning for example orthopedic braces and geriatric chairs.
Security or sitters to monitor patients being evaluated for suicidal ideation
Limb restrains used to restrain violent patient.

11. Nursing Management/ observation
Assess for skin condition before applying device.
Assess patient every minutes: check placement of device, patient positioning, and neurovascular status.
Documentation such as
events/ behavior leading up to the intervention
Prior use of alternative measures
Patient response to the measures
Date and time the restraint was initiated

12. Chemical restraints
Chemical restraints are any medication used for the purpose of restraining patients involuntary to prevent them from harming themselves or staff. The purpose of using medications is long duration of action compare to the brief conscious sedation commonly used to facilitate procedures such as suturing, scanning, and joint reduction.

13. Advantages of Chemical restraints
Control violent behavior and patient agitation
May reduce need for physical restraints
Allow examination and performance of radiographic imaging

14. Disadvantages
May result in complications, such as respiratory depression and loss of gag reflex
Rare paradoxical reaction result in increased agitation
Limit mental status assessment and neurologic examination during sedation.

15. Agents
Agents that commonly used to achieve rapid tranquilization fall in categories of major tranquilizers/ neuroleptic agents. And benzodiazepines.
Tranquilizer/neuroleptinc
Haloperdiol (haldol): decrease agitation and violence behavior and often prescribed for acute psychotic person.
Benzodiazepines: Diazepam, Lorazepam, Midazolam, Xanax.
Diazepam (valium) is used for sedation, treatment of agitation secondary to alcohol withdrawal and treatment of seizer.

16. Complication
Patient may have injuries that result from being restrained. Most injuries are minor and include abrasions and bruises. However, more serious injuries can occur if restraints are inappropriately applied.
Complications from pharmacological sedation are more frequent than from physical restraints.

17. Precautions
Patient dosing is very variable. More medication may be administer if inadequate sedations results after initial dose.
Monitor for respiratory depression and loss of gag reflex.
Immediate inadequate sedation my not mean that the medication is inappropriate for the patient.
Chemical restraint can be effective adjunct or replacement for physical restrains.

18. Reference http://www.medceu.com/index/courses/rest raints.htm59
Susan C. dewit. (2005). Fundamental Concepts and Nursing, ed.2