Transcript Safe Use of Patient Restraint

The Safe
Use of
Patient
Restraints
Mandatory Annual Review Course
Safe Use of Patient Restraint
Definitions
Restraint is:
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 Any method of physically restricting a person’s freedom
of movement, physical activity or normal access to his or
her body.
 Patient immobilization that is a normal component of
a procedure is not considered restraint.
Medical
(Non-behavioral)
Restraint:
 A 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 to protect the patient.
Behavioral Health
Restraint:
 The restriction of patient movement in response to
severely aggressive, destructive, violent or suicidal
behaviors that place the patient or others in
imminent danger.
Restraint is not:
 Forensic restriction used by law enforcement for
security purposes.
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Safe Use of Patient Restraint
Side Rails – Restraint or Not?
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The use of side rails may pose risk to patient’s safety. Clinical judgment
determines whether or not the use of side rails is considered restraints.
 Raising all four side rails to prevent
the patient from exiting the bed
 Four or full side rails to prevent the
patient from rolling our of bed
 Patient actively seizing
 Post-op patient recovering from
anesthesia
 Patient on a gurney
 Raising fewer than four side rails (when
bed has more than two)
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Restraint
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Restraint
Restraint
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Restraint
Restraint
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Restraint
Safe Use of Patient Restraint
Alternatives to Restraints
Restraints must never be used as a substitute for good nursing
care or staff convenience. Restrained patients require MORE
CARE and INCREASED DOCUMENTATION.
PHYSICAL MEASURES
SPIRITUAL NEEDS
Relaxation techniques
Promote normal sleep patterns
Use of lap belt in chair as a reminder
Provide glasses, hearing aid, dentures
Tape foley to abdomen of male patient
Use Activity Apron
Exercise and activities
Anticipate and provide for basic needs
Contact patient’s pastor, minister, priest, rabbi
Offer sacrament of Communion, Reconciliation, Anointing of the Sick
Use sitter or volunteer to read to patient
Use audio tapes, CDs
ENVIRONMENTAL NEEDS
PSYCHOLOGICAL MEASURES
Provide for companionship: family, friends
Orient to reality
Explain all procedures
Use TV, radio, music
1:1 communication
Use of cushions to maintain safety
Locate patient next to Nurse’s station
Use appropriate lighting
Use Geri chair, position commode, walker, near bedside
Decrease noise, control activity level
Place Call light within reach
Position tubes/drains out of site
PHYSIOLOGICAL MEASURES
Collaborate w/other healthcare members
Provide pain medication, eliminate itch
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Initiate frequent bathroom rounds
Review medications for side effects & interactions
Safe Use of Patient Restraint
Patient Assessment
To Determine the NEED for RESTRAINT USE:
 Attempt Alternatives
 Use safe, effective and least restrictive method of restraint
 Clinical Justification based on observed patient actions or behaviors
 Interference with therapy or patient care
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Activity or thoughts with a reasonable probability of harm to self
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Pulling tubes
Picking at wounds
Removing dressings
Wandering
Unsteady gait (high risk for falls)
Suicidal
Activity or thoughts with a reasonable probability of harm to others
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Confused patient striking out at others
Homicidal attempt or talks about killing/harming someone
Violent patient in alcohol or drug withdrawal
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Safe Use of Patient Restraint
Restraint Orders
Restraints will be initiated or continued on the order of a
treating physician. The order must meet the following criteria:
 Reason for the restraint.
 Be time specific
 Include type of restraint.
 Reflect least restrictive manner.
 Be in accordance with safe and
appropriate restraining techniques.
 Be discontinued at the earliest point
in time.
 Never be written as a standing order
or PRN.
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Safe Use of Patient Restraint
Medical vs. Behavior Health Orders
Medical
Behavioral Health
Time
Limitations
24 hours
4 hours 18yrs or older
2 hours 9-17yrs
1 hour 8yrs and under
RN
Assessment
Every 2 hours or sooner
Continuously document every 15
mins
MD
Assessment
Every 24 hours prior to writing
new order
Every 8 hours 18yrs or older
Every 4 hours 17yrs and younger
Emergency
Application by
RN
Notify MD ASAP, within 1 hour
MD must provide telephone or
written order. MD must assess
patient ASAP, within 24 hours.
Notify MD ASAP, within 1 hour MD
must assess patient and write order.
Restraint
Reapplication
Requires new order, and MD assessment. -Even if original order has not
exceeded its “time limit.” This does not include the temporary release that
occurs for patient assessment.
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Safe Use of Patient Restraint
Observation & Monitoring
Assessment will include:
 The patient’s physical and emotional well-being .
 Comfort and care needs, including hygiene, elimination, hydration, nutrition
 The appropriateness of restraint application, removal, and
reapplication
 Assessment of the need for continuing or discontinuing restraint
Patient death associated with
restraint use:
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RN will immediately notify Nurse
Manager or House Supervisor
Complete a UOR (unusual occurrence
report)
Hospitals AR&L Director or designee will
notify CMS
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Safe Use of Patient Restraint
Application of Restraint
 Must have quick-release application
 Use the correct size
 Note “front” and “back” of device
 Secure to bed springs or frame, not mattress or
bed rails
 Do not apply one-sided restraints
 Do not restrain feet while their hands are free
 Place call light and necessary items within
reach
 Do not position pregnant patients 20
weeks or greater on their back, nor should
chest or waist restraints be used
Restraints should be discontinued as soon as it
is no longer indicated by the patient’s actions.
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Safe Use of Patient Restraint
Documentation
Patient basic needs must be attended to,
including:
 Hygiene
 Elimination
 Hydration
 Nutrition
 Circulation
 Range of motion
Document the following in Patient’s record in
KP Health Connect:
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Physician’s order
Initial assessment by the RN and 1 hour in-person evaluation by MD
Patient’s actions or condition that indicated the initial and continued use of
restraint
Less restrictive alternatives considered
Patient monitoring and response to interventions used
Significant changes in the patient’s condition
Reassessment/observations, discontinuation of restraints
Education and information about restraints provided to the patient and family
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