RESTRAINT

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RESTRAINT SECLUSION(R/S) for NON-NURSING
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Definition Restraint

• Restraint
• - Any manual method, physical or mechanical
  device, material or equipment that immobilizes or
  reduces the ability of a patient to move his/her
  arms, legs, body or head freely. If the patient
  can easily remove the device, material or
  equipment, it is not considered a restraint.

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Definition Seclusion

• Seclusion
• The involuntary confinement of a patient in a
  room alone or in an area where the person is
  physically prevented from leaving. It may only
  be used for management of violent or self
  destructive behavior.
• Note
• Seclusion does not include confinement on a
  locked unit or ward where the patient is with
  others.

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When can R/S Be Used?

• Restraint and/or Seclusion may only be used if
  needed to improve the patients well being and
  when less restrictive interventions have been
  determined to be ineffective in protecting the
  patient or others from harm. Once the unsafe
  condition situation ends, the use of R/S will be
  discontinued.

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Are 4 Side Rails up considered a restraint?
Restraint

• Side rails are not considered a restraint when
  used to prevent the patient from falling out of
  bed when on a stretcher, recovering from
  anesthesia, sedated, experiencing involuntary
  movement, or on certain types of therapeutic beds

• Side rails are considered a restraint when used
  to restrict the patients freedom to exit the bed
  unless the patient is able to easily lower the
  side rails.

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Physical Holding
Restraint

• Physical holding is not considered a restraint
  when holding for the purpose of conducting a
  routine physical examination or test. However,
  the patient has the right to refuse treatment.
• Physical holding is considered a restraint if the
  patient is being held against their will.
• Holding the patient down in order to administer a
  medication against the patients wishes is
  considered a restraint.
• In certain emergency situations, with a physician
  order, some patients may be medicated against
  their will (example the behavioral health
  setting)

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Restraint

• NON-VIOLENT OR NON-SELF DESTRUCTIVE RESTRAINT
• Restraint used to limit mobility or temporarily
  immobilize an acute care patient for a reason
  specifically related to a medical or
  post-surgical procedure
• applies to situations in which behavior changes
  are caused by medical conditions or symptoms,
  e.g., confusion or agitation in which protective
  interventions may be necessary
• applies when restraints must be applied to
  directly support medical healing
• Example a patient is attempting to dislodge a
  tube or line or is trying to get out of the bed
  and would compromise healing

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Restraint

• VIOLENT OR SELF-DESTRUCTIVE RESTRAINT
• Restraint used only in an emergency or in a
  crisis situation if a patients behavior becomes
  violent or self-destructive presenting an
  immediate, serious risk to his/her safety or that
  of others and non-physical interventions are not
  effective
• - applies to clinical justification to protect
  self from injury to self or others because of an
  emotional or behavioral disorder where the
  behavior may be violent or aggressive
• NOTE
• The use of R/S for violent/self-destructive
  behavior must be limited to the duration of the
  emergency safety situation regardless of the
  length of the order.

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When to Apply Restraint

• Non-Violent or Non-Self Destructive Restraints
• Patient is pulling at lines, tubes or dressings
• The confused patient is interfering with the
  provision of care
• The patient is attempting an unsafe activity
• patient is thrashing around in bed or attempting
  to get out of bed in a way or under conditions
  where it might cause harm
• patient is exhibiting behaviors related to acute
  withdrawal syndrome
• The patients diagnosis or condition is such that
  they may unpredictably and suddenly awaken and
  harm themselves.
• One example is the intubated patient
• When an intubated patient has a neurological
  condition that may cause them to unpredictably
  and suddenly awaken with a significant risk of
  self-extubation before staff could have an
  opportunity to intervene

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When to Apply Restraint

• Violent or Self-Destructive Restraints
• applies when the patients behavior is
  irrational, uncooperative, aggressive, and/or
  violent and poses a danger to himself/herself or
  others and which behavior may also interfere with
  medical or surgical procedure or medical healing

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Orders

• R/S will be ordered by a physician who is a
  member of the medical staff.
• As needed (prn) R/S orders will not be accepted.
• A trial release is not permitted.
• Temporary release while caring for the patient
  for feeling, range of motion and/or toileting is
  permitted and not defined as a trial release.
• The order will specify the method of R/S to be
  used. Indications will be documented in nursing
  or physicians notes.
• If the initial order is not obtained from the
  patients attending physician, consultation with
  the attending physician will occur as soon as
  possible.
• - The attending physician is the physician who
  is responsible for the management and care of the
  patient.

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General Provisions

• Indications R/S will only be used for the
  protection of the patient, staff members or
  others, hospital property or to maintain
  provision of care. Such indications will be
  present and documented at the initiation of and
  throughout the episode of restraint.
• Least Restrictive Means R/S will not be used
  when less restrictive interventions would be
  effective.
• Early Release R/S will be discontinued by the
  RN or physician when the behavior or condition
  which was the basis for the order is resolved,
  regardless of the duration of the original order.

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Discontinuing R/S

• The use of R/S will be discontinued when there is
  adequate and appropriate clinical justification
  that would indicate that restraint or seclusion
  is no long necessary

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Please Complete the Post Test After Reviewing
The Module