1. MNA M osby ’ s Long Term Care Assistant Chapter 14 Restraint Alternatives and Safe Restraint Use

2. History of Restraint Use Originally thought to prevent falls Actually cause falls Can cause serious harm Can cause death

3. Reasons for Restraint Use Cannot maintain good posture Risk of falls is great and the resident will not call for assistance Tries to pull out tubes Scratches, picks or pulls at wounds, skin, dressings Tries to hit, pinch, bite or injure another person

4. Risks of Restraint Use Agitation Anger Bruises, cuts Depression Embarrass ment Fractures Humiliation Mistrust Nerve injuries Pressure ulcers Strangulation

5. Restraint Alternatives The nurse will try to find the reason for the residents behavior. Pain? Fear? Elimination? Too hot or cold? Hungry, thirsty? Confusion? Drugs?

6. Restraint Alternatives Find Diversional activities Provide time in supervised areas Use positioning aids Keep signal lite within reach Ensure that food, fluid and elimination needs are met

7. Restraint Alternatives Allow visitors Provide calm, quiet setting Use warning devices Uninterrupted sleep provided Keep noise levels reduced

8. Safe Restraint Use Restraints can be dangerous They are not used for: Staff convenience Punishment When restraints are used OBRA guidelines must be followed

9. Safe Restraint Use Physical Restraints Manual, physical or mechanical device Is attached to or next to the person ’ s body Cannot be easily removed by resident Restricts freedom of movement

10. Safe Restraint Use Chemical Restraints Drugs used to prevent a certain behavior or movement

11. Safety Guidelines If a restraint is necessary it must be the least restrictive method. Restraints require a doctor ’ s order. Unnecessary restraint is false imprisonment. Informed consent is required. You must follow manufacturer ’ s instruction for correct application.

12. Safety Guidelines Resident ’ s basic needs must be met. Used for as short a time as possible. Resident must be observed q15 minutes or more often prn. Restraint must be removed Q2H for skin care and re-positioning.

13. Safety Guidelines Restrained resident must be placed in good body alignment. Pad bony areas and skin. Tie with quick release knots. Never secure restraints to bed rails.

14. Safety Guidelines Keep restraint in plain view at all times. Circ checks q 15 minutes. Document each time you check the resident.

15. Applying Restraints Cloth (soft) Restraints Mitts Belts Straps (ankle or wrist) Jacket Vests Applied to wrist, hands, ankle, waist and chest.

16. Applying Restraints Leather Restraints Applied to wrist and ankles Used only for extreme cases of agitation and combativeness.

17. Cloth (Soft) Restraints Wrist - Limit movement of arms Ankle - Limits movement of legs. Mitt - prevents finger use Vest and Jacket - Prevent resident from getting out of bed or chair. Belt - Prevent resident from getting out of bed or chair.

18. Jacket/Vest Risk Factors Strangulation and death if applied incorrectly. Would be best if applied by nurse and assisted by nursing assistant.

19. Applying Restraints Questions about application? Mitt restraints – use a hand roll to prevent contractures

20. Review If restraint alternatives fail to protect a resident, the nurse can order a restraint TrueFalse

21. Review Restraints can be used for staff convenience. TrueFalse

22. Review What type of restraint is this? Belt restraint

23. Review Bedrails are considered restraints by OBRA. TrueFalse

24. Review A device is a restraint only if it is attached to the residents body. TrueFalse

25. Review Restraints can be used to prevent the resident from harming others. TrueFalse

26. Review Unnecessary restraint is considered __________ _______________ falseimprisonment

27. Review Restraint straps are secured within the resident’s reach. TrueFalse

28. Review Restrains are removed ___________ Q2H

29. Review A vest restraint crosses in the front TrueFalse

30. Review How often is a restrained resident checked? Q15 minutes

31. Review How can you check to see if a wrist restraint is too tight? Pulse (radial) 2 fingers under restraint Capillary refill Color, movement, temperature of hand

32. Review How can you check to see if an ankle restraint is too tight? Pulse (pedal) 2 fingers under restraint Capillary refill Color, movement, temperature of feet

33. Review How can you check to see if a jacket or vest restraint is too tight? respirations 2 fingers under restraint Difficulty breathing Color, temperature of face

34. Review Restraints are tied to the moveable part of the bed frame. TrueFalse

35. Review What special action is taken when using mitt restraints?. Place a rolled wash cloth in hand

36. Review You can use towels or tape to restrain a resident if necessary? TrueFalse

37. Review What is normal pulse rate? 60 - 100

38. Review What is normal respiration rate? 12 - 20

39. Questions?