1. Chapter 12-Restraints

2. 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

3. 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.

4. 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

5. 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

6. 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

7. Risks of restraints
Page 161-box 12-1

8. 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

9. 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.

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

11. 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.

12. 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

13. 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

14. 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

15. 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.

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

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

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

24. Page 165/166