1. Alternatives to Restraints/Restraints Workshop

2. Definitions What is a restraint? –A restraint can either be physical or chemical and is used to limit activity or to control an individual’s behavior.

3. Alternatives to Restraint Patients have the right to control their own body and their actions. But What Happens When They Become A Risk To Themselves And Others?

4. Alternatives to Restraint The First Step one must consider before physical or chemical restraints are applied / administered depends on: –Is the patient demonstrating disruptive behavior because they are –Frustrated –Anxious –Bored –Confused

5. Alternatives to Restraint If you can answer “yes” to any of those questions, consider ways to alter or change the patient’s environment. –Walking –Exercise –Reduce noise level to allow the patient to sleep and to reduce their agitation. –Turn the TV off. –Use bed/chair check –Use family members; get sitters

6. Alternatives to Restraint Why are alternatives to restraints so important? –Patients become weaker with immobilization. –Restraint devices increase agitation. –Patients who are restrained are at a greater risk of falling and sustaining more serious injuries if they do fall. –Psychological side effects can include feelings of anger, loss of dignity and depression. Smith, N., Timms, J., Parker, V., Reimels, E., Hamlin, A. (2003). “The impact of education on the use of physical restrains in the acute care setting.” The Journal of Continuing Education in Nursing. 34(1): 26-33.

7. What is the difference between… Acute Medical / Surgical Restraints & Behavioral Health Restraints Alternatives to Restraint

8. Medical / Surgical Restraint Rule of thumb… If the patient is at risk for interruption of the medical treatment plan, such as pulling out tubes with agitation, he or she meets the criteria for a Medical / Surgical Restraint

9. Behavioral Health Restraint Rule of thumb… A patient who is at risk for imminent harm to either himself or someone else due to violent behavior, he meets the criteria for a Behavioral Health Restraint.

10. Case Scenario What category of restraint would be used for this situation… A female patient returns from surgery and is confused and attempting to pull out her IV and foley catheter. After alternative methods of redirecting her from pulling out her lines have failed, which criteria for restraint would this patient fall under?

11. Case Scenario What category of restraint would be used for this situation… A male patient is admitted with an elevated blood alcohol level. He is admitted to your unit with IV therapy running. He attempts to pull out his line. When you try to redirect him, he verbally threatens you and tries to kick you away from his bed with a purposeful aim, which criteria for restraint would this patient fall under?

12. Alternatives to Restraint Disposable Freedom Splint (alternative to limb holder) (SDS) The following products are alternatives to restraints

13. Alternatives to Restraint Self Releasing Lap Hugger (Unit Purchase) The following products are alternatives to restraints

14. Alternatives to Restraint F Wedge Foam Cushion (Unit Purchase) The following products are alternatives to restraints

15. Bedfellow Positioning Roll (Unit Purchase) cover with a sheet* The following products are alternatives to restraints Alternatives to Restraint

16. Peek a Boo Mitts (SDS) The following products are alternatives to restraints Alternatives to Restraint

17. Types of Restraints If All Else Fails… Remember that the care of the patient while he or she is in the restraint is part of a process that requires the health care team to provide quality care. This care is measured by careful documentation! Types of Restraints –Disposable quick release limb restraint –Side Rails –Locked restraint

18. Performance Improvement Documentation Patient Care

19. Safety Concerns Physicians order must be obtained within one hour of initiation of restraints.

20. Safety Concerns Documentation should include: –The need for restraints –The alternatives that were applied to avoid restraint usage –Notification of Family –Time the restraint was initiated or discontinued –The type of restraint in use

21. Safety Concerns Documentation should include: –That observation and patient care needs / assessments were met –The patient’s behavior while in restraints –Ongoing communication with the patient and their family concerning the termination of restraint measures

22. Assessment / Care of the Patient in Restraints Restraints for Medical Reasons… –Monitor and Observation of Patients every 2 hours. –Observation includes: Respiratory Status Circulation Signs of Distress Change in Behavior –Patient Care every two hours and prn includes: Comfort measures Fluid and nutritional needs Toileting needs Check circulation of restrained limbs Range of Motion and Repositioning –Continue to try alternatives and to eliminate the cause for the use of restraints. –Reassessment / MD Order daily and prn –Ongoing patient / family teaching related to criteria for removal of restraints.

23. Restraints for Behavioral Management… –Patient will be placed on 1:1 observation –Examine Patient and room for contraband –Order a “disposable tray” for patient meals –Modify treatment plans with interventions to eliminate the restraints. –Reassessment under direction of RN every 15 minutes Observation and Assessment Patient Care Assessment and Needs –Continue to try alternatives to eliminate the cause for the use of the restraints. –Reassessment for the need for restraints: By RN every 4 hours ( 2 hours for adolescents) By MD every 8 hours (4 hours for adolescents) Assessment / Care of the Patient in Restraints

24. Questions?