Unit 15 Restraints

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Unit 15Restraints

• Nurse Aide I Course

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RestraintsIntroduction

• Under OBRA, residents have a right to be free
  from restraints.
• As a member of the multidisciplinary team, the
  nurse aide plays an integral role in achieving a
  restraint free environment.

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RestraintsIntroduction(continued)

• When alternatives to restraints are not
  effective, however, and the physician orders
  restraints, it becomes essential for the nurse
  aide to know the risks involved in caring for
  these residents.

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Facts Regarding Restraints
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• 15.0 Identify and discuss the safety precautions
  to be considered when using restraints.

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Facts Regarding Restraints

• Ordered by the physician when necessary to treat
  a medical symptom or provide emergency medical
  treatment
• Choice of restraint based on multidisciplinary
  evaluation for the least restrictive measure

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Facts Regarding Restraints(continued)

• Types of acceptable restraints
• hand or mitts
• soft ties for wrists and ankles
• vests and safety belts
• lap cushions
• lap trays

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Facts Regarding Restraints(continued)

• Types of unacceptable restraints
• using bed rails to keep resident from voluntarily
  getting out of bed
• tucking in top sheet so tightly that resident
  cannot move
• using wheel chair safety bars to prevent resident
  from getting out of chair

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Facts Regarding Restraints(continued)

• Types of unacceptable restraints (continued)
• placing resident in wheel chair so close to a
  wall that the wall prevents resident from getting
  out of chair

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Facts Regarding Restraints(continued)

• Reasons for use of acceptable restraints
• Temporarily for life threatening medical
  conditions
• Brief periods to allow medical treatment to
  proceed if there is documented evidence of
  resident or legal approval of treatment

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Facts Regarding Restraints(continued)
May not be used for convenience or discipline
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• 15.1 List eight considerations that would be
  important when using restraints.

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Considerations When Using Restraints

• Used to protect residents and not to aid staff
• Restraints require physicians order
• Need for restraint should be apparent
  (unnecessary use is false imprisonment)

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Considerations When Using Restraints(continued)

• Staff must provide for the restrained residents
  basic needs, with special attention to
  elimination needs

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Considerations When Using Restraints(continued)

• Secure enough help to apply restraints quickly to
  prevent injury
• Use reassurance in an attempt to calm agitated
  residents in restraints
• Apply according to manufacturers directions

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Safety Measures For Restrained Residents

• Check on resident frequently
• Apply restraint only after you have received
  instructions in its use
• Protect bony areas and skin by padding them prior
  to applying restraint
• Adjust restraint so that it allows some movement,
  but is secure

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Safety Measures For Restrained Residents(continue
d)

• Assure that resident can breathe easily in a vest
  restraint
• Check pulse, color and temperature of any
  restrained extremity and breathing of resident in
  vest restraint every 15 minutes

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Safety Measures For Restrained Residents(continue
d)

• Use slip knot to tie restraint for quick release
• Secure restraints to bed frame, not to side rails

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Safety Measures For Restrained Residents(continue
d)

• Loosen restraint, stay with resident, and use
  call signal to notify supervisor immediately
• when unable to detect a pulse in restrained
  extremity
• when fingers/toes are cold, pale or blue in color

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Safety Measures For Restrained Residents(continue
d)

• Loosen restraint, stay with resident, and use
  call signal to notify supervisor immediately
  (continued)
• if resident complains of pain, discomfort,
  numbness, or tingling in restrained part

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Safety Measures For Restrained Residents(continue
d)

• Loosen restraint, stay with resident, and use
  call signal to notify supervisor immediately
  (continued)
• when skin appears red or damaged under restraint
• when breathing is impaired with vest or safety
  belt restraint

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Safety Measures For Restrained Residents(continue
d)

• Carry scissors in pocket to cut restraints in
  emergency situations
• Remove restraints for 10 minutes and reposition
  resident every two hours

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Safety Measures For Restrained Residents(continue
d)

• Be sure resident needs are met when restrained
• Keep call signal within residents reach

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Safety Measures For Restrained Residents(continue
d)

• Recording restraints should include
• The type of restraint
• wrist
• ankle
• waist belt

• mitt
• vest

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Safety Measures For Restrained Residents(continue
d)

• Recording restraints should include (continued)
• Time restraint applied
• Each time restraint loosened and resident
  repositioned
• Time restraint removed
• Condition of resident

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Safety Measures For Restrained Residents(continue
d)

• Observations and reporting should include
• Color and condition of skin under restraint
• Pulse rate, color and temperature of skin in
  restrained extremity

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Safety Measures For Restrained Residents(continue
d)

• Observations and reporting should include
  (continued)
• Any complaints about restrained part
• Red or injured skin areas under restraint
• Respiratory rate and color of skin with vest and
  safety belt restraints

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Demonstration and Return Demonstration
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• 15.2 Demonstrate the application of restraints.

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• 15.3 Demonstrate the application of a safety belt
  restraint.

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Alternatives To The Use Of Restraints
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• 15.4 Identify a sampling of alternatives to avoid
  the use restraints.

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Alternatives To The Use Of Restraints

• Using friends, family, volunteers or sitters  
• Diverting with interesting activities
• Answering call signal promptly 
• Exercise and outdoor activities 

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Alternatives To The Use Of Restraints(continued)

• Electronic warning devices on beds and doors 
• Consistent reality orientation and staff
  assignments 
• Having room close to nurses station

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THE END