1. By Dymond Unutoa

2.  Understand the definitions of Restraint  Understand Restraint purposes  Recognize Types of Restraints  Know possible Alternatives before Restraining  Understand the process of Restrain Application  Recognize Complications with Restraint use  Understand how Physical Therapy can be Involved  Recognize Non-Restraints

3.  1) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely; or  2) A drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition

4.  Protection from self and others upon display of violent and unsafe behavior in environment/situation  Care management for a patient who exhibits behavior that is interfering with POC or intervention (i.e. pull on tube/IV)

5. NON-VIOLENT OR NON-SELF DESTRUCTIVE VIOLENT/SELF DESTRUCTIVE  Pulling at Invasive Tubes or Lines  Patient safety – Attempts to leave bed when exhibiting disorientated/confused behavior with potential injury to self  Interruption of surgical/wound maintenance (picks at site)  Emergency Behavioral Situation – Physically aggressive with significant potential to harm self or others

6.  Sitter  Wrist/Ankle Soft  Wrist/Ankle Leather  Posey Vest  Mitt  All 4 side rails engaged  Belts

7.  Chemical - Tranquilizers – Decrease agitation in acutely psychotic patients - Benzodiazepines (Valium) - Lorazepam – Elderly, long duration - Midazolam – Rapid sedation, short duration

8.  Alternatives  Preserving patient rights and dignity  Safe application  Environment – Their access to surroundings  Patient’s ability to participate in POC  Risks associated – Behavior, child, cognitive

9.  Encouragement for family involvement  Patient location in relation to staff  Position of patient bed  Use of Call bell  Bed/Exit Alarms  Reorient patient to environment  Conceal IV/Tube sites

10.  Assessment for restraint use performed by RN  Physician or LIP that’s authorized to elicit restraint use can do so as per hospital policy  Checked every 15 min  Orders in writing  Orders must not exceed 24 hrs

11.  Injury – Abrasions and Bruises *Inappropriate application can lead to serious injury  Pressure sores  Circulation disruption  Loss of gag reflex - Sedation  DEATH

12.  Collaborate with on-care nurse.  Patient education  Assessment of potential physiological outcomes  Orientation – Psychological/Cognitive patients  Intervention planning and POC  Family education

13.  Orthopedically prescribed devises  Surgical dressings  Bandages  Any device that can be manually removed by patient in same manner as applied.

14.  Does knowledge without action become neglect? – Safe Patient Handling

16.  IASIS Health Care Risk Management Manual. Origination (9/28/08). Restraint and Seclusion (Section: Clinical Risk Policy Number: RMCO.011)  MedCEU Restraint Continuing Education Course. http://www.medceu.com/index/index.php?page=get_course&courseID =3631&nocheck. Accessed November 17, 2012 http://www.medceu.com/index/index.php?page=get_course&courseID =3631&nocheck  Haut A, Kolbe N, Strupeit S, Mayer H, Meyer G. Attitudes of Relative of Nursing Home Residents Toward Physical Restraints. Journal of Nursing Scholarship [serial online]. 2010;42:4,448-456  Williams D. Restraint Safety: an Analysis of Injuries Related to Restraint of People with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities [serial online]. 2009;22:135-139.  Wilson C, Klein A, Kirsch N (Michigan Chapter). Proposal RC 29-12 – The Role of PT in patient handling. Adopted June 2012 in House of Delegates to APTA.  Gulpers M, Bleijlevens M, Ambergen T et al. Belt Restraint Reduction in Nursing Homes: Effects of a Multicomponent Intervention Program. J Am Geriatr Soc [serial online]. 2011;59:2029-2036. Accessed November 19, 2012.