Chapter 12-Restraints

Question Restraints are used  To prevent falls Question Restraints are used  When the nurse thinks that they are needed  When the health team thinks that they are needed  When other measures fail to protect the person  To prevent falls

RESTRAINTS May ONLY be used when less restrictive measures fail to protect the person or others. They MUST be discontinued at the earliest possible time.

History Once upon a time. . .used to prevent falls-now know they cause falls Once used to prevent wandering Used more on older than younger Now know they can cause serious harm/even death

Regulatory Agencies CMS-Centers for Medicare & Medicaid FDA – Food & Drug Administration TJC-The Joint Commission OBRA-Omnibus Reconciliation Act They do not forbid, but they do require considering or trying all other appropriate alternatives first. AND, that must be documented Page 163 has a documentation example

Restraint Alternatives Page 161& 162 *Look at reasons for the behavior Trying to pull out an IV-wrap with gauze Give them rolled up washcloths in their hands Give them wash cloths to fold Turn on television Give them an activity

Risks of restraints Page 161-box 12-1

Chemical Restraints An example of a chemical restraint is pline Chemical Restraints An example of a chemical restraint is Jacket restraint Person sitting at bedside Pair of cloth mitts attached to hands only Drug that is used for discipline

Question You visit your grandmother every day right after school. Your mother visits every day right after work. For the past week, when you come, she doesn’t talk a lot. By the time your mother gets there, she is asleep every day. You go to talk to her nurse and it’s not the same nurse that has been taking care of your grandmother.

Chemical Restraints Any medication that is used for discipline or convenience and not required to treat medical symptoms.

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

Freedom of Movement Change in place or position of the body or any part of the body that the person is physically able to control

Examples: Trays, tables, belts, bars A chair that prevents the person from standing A bed or chair placed so close to a wall that it prevents the person from getting out of the bed or chair Bed Rails Tucking in a sheet/using Velcro to hold the sheet, tight clothing that restricts movement

Restraint Rules 1. You MUST have a doctors order 2. You MUST have documented use of least restrictive measures first 3. You MUST check every 15 minutes & document 4. You MUST remove after 2 hours 5. You MUST document all-restraint use book is usually kept at the nurses desk-you MUST also document in personal file

Complications Mental effects-affects dignity & self-esteem Restraints are medical devices CMS requires the reporting of any death-while a person is in a restraint; within 24 hours after a restraint was removed; within 1 week after a restraint was removed if the restraint may have contributed directly or indirectly to the person’s death.

Legalities *Restraints must protect the person A doctor’s order is required The least restrictive method is used Restraints are used only after all other measures fail to protect the person Unnecessary restraint is false imprisonment Informed consent is required

Safety Observe for increased agitation/confusion Protect the person’s quality of life Follow the manufacturers instructions Apply restraints with enough help to protect the person and staff from injury Observe the person at least q 15 minutes or as often as noted on the care plan Remove or release the restraint, re-position the person and meet basic care needs at least every 2 hours or as often as noted on care plan

Procedure The person has the restraint removed for at least 10 minutes and food, fluid, comfort, hygiene and elimination needs are provided. Skin care, range-of-motion exercises and help the person to walk

Documentation Type of restraint applied-mitt/vest, etc. Body part restrained Reason for application Safety measures taken Time restraint was applied Time you removed or released the restraint and for length of time Person’s vital signs The care given when the restraint was removed or released Skin color/condition Condition of limbs Pulse felt in restrained part

Which statement about restraints is correct?  Any member of the health team can order a restraint to protect the resident.  Unnecessary restraint is discouraged.  Verbal approval is required before a restraint is applied.  The manufacturer’s instructions are followed

You check your resident that has on a restraint and do not feel a pulse in the extremity. What do you do first? A. Contact the doctor B. Contact the family C. Remove the restraint D. Contact the supervisor

Which is a restraint?  A chair with an attached tray table  A rocking chair  A reclining chair  A low bed

Before applying a restraint, the person must be  Sitting  Lying down  In good alignment  Resting quietly

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