1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Textbook for Nursing Assistants Chapter 10: Patient Safety and Restraint Alternatives

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Accidents and Incidents and the PCT Role to Prevention

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins What you will learn? Define accident and incident Identify risk factors that put people in health care facilities and increased risk Understand the importance of reporting accidents and incidents List and identify the various types of restraints Identify safety concerns of restraints Describe methods to reduce the need for restraints

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins An accident is an unintended, unexpected event that has the potential for causing bodily harm An incident is an occurrence that is considered unusual, undesired, or out of the ordinary that disrupts the usual routine of the patient, the resident or the facility Accidents and incidents can involve patients, residents, staff or visitors of a facility Accidents and Incidents

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Facilities are required by OBRA to maintain an environment that lowers the risk of accidents and incidents to the greatest possible extent Facilities achieve this by providing patients and residents with adequate supervision and assistance to prevent the occurrence of accidents and incidences Accidents and Incidents

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Some factors that place people at risk for accidents are – Age – Medication effects – Impaired mobility – Sensory impairment Risk Factors That Cause Accidents

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Infants are helpless –accidental suffocation –falls Young children lack knowledge about things that are dangerous –falls –burns –poisoning and drowning The elderly are at high risk for accidents because of the physical and mental effects of the aging process Risk Factor: Age

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Many medications can affect the ability of a person to be safe including –Pain medications –Medications that affect blood pressure Effects of medication can be –Dizziness –Sedative effect –Confusion Risk Factor: Medication

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The person is unable to move or feel part of the body Puts the person at a risk of falls, burns, and other injuries Caused by a spinal cord injury or a stroke (“brain attack”) Paralysis from the waist down is known as paraplegia Paralysis from the neck down is known as quadriplegia Paralysis on one side of the body is known as hemiplegia Risk Factor: Paralysis

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors associated with poor mobility are –Pain and stiffness from arthritis –Conditions that cause a person to shuffle his feet when he walks (e.g., stroke) –Injuries or surgeries involving the leg Risk Factor: Poor Mobility

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Visual impairment can lead to –Falls, accidental poisonings Hearing impairment can lead to –Road accidents, suffocation or fire accidents, accidental poisonings Impaired sense of touch can lead to –Accidental burns Impaired sense of smell can lead to –Food poisoning, suffocation, or fire accidents due to gas leak Risk Factor: Sensory Impairment

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Confusion and disorientation caused by reactions to medication, head injuries, dementia, and other medical conditions can lead to accidents A person who is unconscious or comatose is totally unable to respond to his or her environment and needs assistance to remain safe Risk Factor: Limited Awareness of Surroundings

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reporting and the PCT

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins An accident should be reported immediately and an incident (occurrence) report should be completed promptly The report is to be completed in an objective and nonjudgmental way, without blaming anyone Reporting

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Using Restraints

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Restraints are used to –restrict a person’s freedom of movement –prevent a person from reaching parts of his or her body –confine a person to a bed or a chair –prevent movement of a specific body part Restraints can be either –Physical or –Chemical Restraints-MUST HAVE DR ORDER

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins A physical restraint can be applied to –Wrists –Ankles –Chest –Waist –Arms or Elbows Some types of chairs or attachments to chairs can act as restraints The side rails of beds or tightly tucked sheets can act as restraints Not permitting a person free access to other rooms or parts of the facility is also considered a form of physical restraint Physical Restraints

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Vest or POSEY

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Wrist or Ankle Restraint

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Lap buddy and Chairs with Tables

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Side Rail Entrapment

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins A chemical restraint is any medication that alters a person’s mood or behavior Chemical restraints are sedatives or tranquilizers Chemical restraints are used to calm an anxious, combative (physically aggressive), or agitated (very upset) person Chemical restraints are not used for staff convenience Chemical restraints should not be used in so high a dose as to make the person sleepy or unable to function in a normal fashion Chemical Restraints

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Examples of some situations where the use of a restraint may be appropriate: –A person is at risk for falling but will not stay in his bed or a chair and will not call for help –A person may wander away from the facility –A person tries to remove tubing needed for medical treatment –A person is combative (physically aggressive) Using Restraints

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Strangulation, which can lead to death Bruises, nerve damage, and skin abrasions Permanent tissue damage as a result of impaired blood flow Broken bones Pneumonia, pressure ulcers, and blood clots Mental effects such as agitation, increased confusion, humiliation, and embarrassment Complications Associated With Using Restraints

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Only a doctor can order a restraint for a patient or resident Always follow your facility’s policies regarding the application and use of restraints Only a registered nurse (RN) or a licensed practical nurse (LPN) can apply a restraint Nursing assistants are responsible for providing care for the person while he or she is restrained Applying Restraints

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Quick Release KNOT & other safety tips To make a quick release knot –Make a regular overhand knot –Slip a loop through the first loop – NEVER tie any restraint to the side rail – all restraints must be tied to the bed frame –Never have the patient completely flat in bed with a restrain on

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins What Should you Document --- Type of restraint Time of restraint application Patients response to the restraint Position of the patient Food or fluids taken Elimination results Skin care given ROM which were performed while restraints were in place

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation