Patient Restraints and Restrictive practices Policy No. 503.073

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Patient Restraints and Restrictive
practicesPolicy No. 503.073
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Philosophy cont.

• The organization seeks to prevent, reduce, and
  eliminate the use of restraints or restrictive
  practices. Restraints should be used only to
  protect the patients health and safety while
  preserving the dignity, rights and well-being of
  the patient.

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Alternatives to restraints

• Offer/assist to bathroom or commode
• Diversional activities
• Consider sources of confusion medications,
  pain, infection, hypoxia

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Alternatives to restraints

• Cover tubes
• Relaxation techniques
• Contact physician for further intervention
• Personal alarms/bed alarms

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Alternatives to restraints

• Reorientation
• Frequent contact
• Move closer to nurses station
• Family/sitter

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Alternatives to restraints

• Visual reminders
• Reposition or ambulate
• Decrease stimulation
• Obtain a physicians order to remove any
  unnecessary tubes

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Four typesof restraints

• Physical
• Chemical
• Seclusion
• Therapeutic
• Holding/Physical
• redirection

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Assessment/Reassessment criteria

• All patients will have an assessment performed to
  determine safety and protective needs prior to
  the application of restraints, including patient
  and family as appropriate.
• The use of restraints will be frequently
  evaluated and discontinued at the earliest
  possible time based on the assessment of the
  patients condition.

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Physical

• Any manual method or physical or mechanical
  device, material or equipment that immobilizes or
  reduces the ability of a patient to freely move
  his or her arms, legs, body or head freely.

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The following are not considered restraints

• Orthopedic devices
• Protective helmets
• Methods that involve the physical holding of a
  patient for the purpose of conducting routine
  physical exams or tests.

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The following are not considered restraints

• Using all four side rails for patients in
  specialty beds, i.e. stretchers or patients
  experiencing involuntary movements, i.e. padded
  siderails for seizure activity.

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The following are not considered restraints

• Forensic and corrective restrictions imposed by
  correction authorities.
• Age appropriate child care equipment such as
  crib rails or swing, stroller and high chair
  safety belts.

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Application of restraining devices

• Secure the limb restraint to the part of the bed
  frame that moves up when the head of the bed is
  elevated.
• Secure the limb restraint with a quick release
  knot like the slip knot.
• Do not tie in a knot!

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Safe Application of soft wrist restraints
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Leather restraints

• If using a locked restraint device verify you
  have immediate access to the key.

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Safe Application of leather restraints
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Indications for removal of restraints

• When the patient demonstrates a change in the
  behavior that was the reason for the initial
  application.
• If the behavior has decreased so the risk to the
  patient and others is no longer present the
  restraint may be removed.

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Chemical

• Any medication that is used as a restriction to
  manage the patients behavior or restrict the
  patients freedom of movement and is not
  standard treatment or dosage for the patients
  condition.

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Seclusion

• The involuntary confinement of a patient alone in
  a room or an area where the person is physically
  prevented from leaving.
• Used in the Emergency Department

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Therapeutic holding/physical redirection

• The process of holding a patient in a manner that
  restricts movement

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Leadership Notification and Reporting Requirements

• The Department Director or Clinical Coordinator
  will be notified of potential need for use of
  restraints prior to application except in an
  emergency situation
• The Department Director or Clinical Coordinator
  will evaluate whether additional resources are
  required to facilitate discontinuation of
  restraints or minimize recurrent episode.

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Monitoring Reassessment- timeframes

• Maintenance of Therapy/Promotion of Healing- is
  monitored every two hours
• Violent and Self-Destructive - require an
  initial assessment when restraints are initiated
  then every 15 minutes thereafter

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Monitoring and reassessment- requirements

• Signs of physical and psychological distress,
  i.e. positional asphyxia, will be recognized and
  responded to in accordance with the Rapid
  Response policy PCM - 503.200, CPI training and
  department specific Violence Control plans.

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First Aid Interventions

• For minor injuries such as bruises, cuts or
  scrapes
• Contact the physician for treatment orders.
• Adhere to Skin impairment policy- PCM policy
  502.007
• Pressure ulcer prevention - PCM-502.007

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Monitoring and reassessment- requirements

• General well-being
• Respiratory/Circulatory status
• Need for fluid/food hydration
• Social needs or requests
• Potential for release/ removal
• Vital signs
• Comfort
• Signs of injury associated with restrictive
  practice

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Transportation of restrained patients

• Restraints will be maintained throughout
  transport with the appropriate intensity of
  observation
• When restraints need to be removed for tests or
  procedures/treatments, the patient will be
  observed during that period restraints
  reapplied prior to transport back to the unit
• Documentation will continue as appropriate for
  the patient type of restrictive practice
• Upon returning to the department the restraint
  application will be reevaluated

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Staff Education

• All staff having direct patient contact must
  have
• Crisis Prevention Intervention training
• First Aid training
• CPR training