RESTRAINT ALTERNATIVES

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CHAPTER 9 RESTRAINT ALTERNATIVES

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RESTRAINT ALTERNATIVES

• TRY TO DISTRACT THE PERSON FROM THE BAD
  BEHAVIOR
• MAINTAIN THE PERSONS DAILY SCHEDULE AS MUCH AS
  POSSIBLE
• SIGNAL LIGHT WITHIN REACH
• ELIMINATION NEEDS ARE MET
• A SITTER MAY BE NEEDED
• EXTRA TIME IS SPENT WITH THE PERSON
• WARNING DEVICES ON BEDS, CHAIRS, DOORS
• MOVE THE PERSON CLOSER TO THE NURSES STATION
• CHECK ON THE PERSON FREQUENTLY
• NOTE ANY INTERVENTIONS ON THE CARE PLAN

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ALTERNATIVES TO RESTRAINTS
LAP PILLOW
ALARM
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SAFE RESTRAINT USE

• RESTRAINTS ARE NOT USED FOR DISCIPLINE OR STAFF
  CONVENIENCE
• RESTRAINTS ARE USED ONLY WHEN NECESSARY TO
  TREAT A PERSONS MEDICAL SYMPTOMS
• RESTRAINTS ADD TO A PERSONS CONFUSION AND
  COMBATIVENESS

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RESTRAINTS
A RESTRAINT IS ANY ITEM, OBJECT, DEVICE, GARMENT,
MATERIAL, OR CHEMICAL THAT RESTRICTS A PERSONS
FREEDOM OF MOVEMENT OBRA STATES THAT RESIDENTS
HAVE THE RIGHT TO BE FREE FROM RESTRAINTS OBRA
ALLOWS RESTRAINTS TO BE USED ONLY TO ENSURE THE
SAFETY OF THE RESIDENT OR OF OTHER RESIDENTS
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RESTRAINTS

• PHYSICAL RESTRAINT
• MAY BE ANY MANUAL METHOD, PHYSICAL OR
  MECHANICAL DEVICE, MATERIAL, OR EQUIPMENT
• ARE ATTACHED TO OR NEXT TO THE PERSONS BODY
• CANNOT BE EASILY REMOVED BY THE PERSON
• RESTRICT FREEDOM OF MOVEMENT OR ACCESS TO ONES
  BODY

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EXAMPLES OF PHYSICAL RESTRAINTS

• RESTRAINTS APPLIED TO THE CHEST, WAIST, ELBOWS,
  WRISTS, HANDS, OR ANKLES
• GERI CHAIRS
• BED RAILS
• SHEETS TUCKED IN SO TIGHTLY THAT THEY RESTRICT
  MOVEMENT

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RESTRAINTS

• CHEMICAL RESTRAINTS
• DRUGS THAT ARE NOT STANDARD TREATMENT FOR THE
  PERSONS CONDITION
• DRUGS USED TO DISCIPLINE A PERSON OR FOR STAFF
  CONVENIENCE
• DRUGS ARE CONSIDERED CHEMICAL RESTRAINTS WHEN
  THEY AFFECT THE PERSONS PHYSICAL AND MENTAL
  FUNCTION

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HARMFUL EFFECTS OF RESTRAINTS

• MUSCLE WEAKNESS
• LOSS OF MOBILITY
• INCONTINENCE
• SKIN BREAKDOWN
• DECREASE IN ACTIVITY
• INCREASE IN CONFUSION AND AGITATION
• CUTS AND BRUISES
• DEPRESSION
• EMBARRASSMENT AND HUMILIATION
• FRACTURES
• STRANGULATION

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LEGAL ASPECTS

• IF A RESTRAINT IS USED, THE LEAST RESTRICTIVE
  METHOD MUST BE USED
• RESTRAINTS ARE USED TO PROTECT THE PERSON, NOT
  FOR STAFF CONVENIENCE
• RESTRAINTS REQUIRE A DOCTORS ORDER
• THE DOCTOR MUST GIVE THE REASON FOR THE
  RESTRAINT AND THE TYPE TO BE USED
• THE ORDER MUST ALSO INCLUDE HOW LONG THE
  RESTRAINT IS TO BE APPLIED
• RESTRAINTS ARE USED ONLY AFTER TRYING OTHER
  METHODS TO CONTROL OR PROTECT THE PERSON

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LEGAL ASPECTS

• UNNECESSARY RESTRAINT IS FALSE IMPRISONMENT
• RESTRAINTS REQUIRE THE PERSONS INFORMED CONSENT
• IF THE PERSON CANNOT GIVE INFORMED CONSENT, THE
  PERSONS LEGAL REPRESENTATIVE MUST BE GIVEN THE
  NECESSARY INFORMATION
• RESTRAINTS MUST BE USED ACCORDING TO THE
  MANUFACTURERS INSTRUCTIONS
• YOU COULD BE FOUND NEGLIGENT FOR IMPROPERLY
  APPLYING A RESTRAINT
• THE RESTRAINED PERSONS BASIC NEEDS MUST BE MET
  BY THE NURSING TEAM.

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SAFETY GUIDELINES

• OBSERVE FOR INCREASED CONFUSION AND AGITATION
• PROTECT THE PERSONS QUALITY OF LIFE
• FOLLOW THE MANUFACTURERS INSTRUCTIONS
• APPLY RESTRAINTS WITH ENOUGH HELP TO PROTECT
  THE PERSON AND STAFF FROM INJURY
• OBSERVE THE PERSON AT LEAST EVERY 15 MINUTES OR
  MORE OFTEN AS REQUIRED BY THE CARE PLAN
• REMOVE THE RESTRAINT, REPOSITION THE PERSON,
  AND MEET BASIC NEEDS AT LEAST EVERY 2 HOURS

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SAFETY MEASURES

• USE THE CORRECT RESTRAINT IN THE CORRECT SIZE
• DO NOT USE SHEETS, TOWELS, TAPE, ROPE, STRAPS,
  BANDAGES, OR OTHER ITEMS TO RESTRAIN A PERSON
• DO NOT USE RESTRAINTS THAT ARE TORN OR FRAYED
• FOLLOW AGENCY POLICIES AND PROCEDURES
• POSITION THE PERSON IN GOOD ALIGNMENT BEFORE
  APPLYING THE RESTRAINT
• PAD BONY AREAS AND SKIN
• THE RESTRAINT SHOULD BE SNUG BUT ALLOW SOME
  MOVEMENT OF THE RESTRAINED PART
• SECURE STRAPS OUT OF THE PERSONS REACH
• SECURE THE STRAPS TO THE BED FRAME, NEVER THE
  BEDRAILS
• CHECK THE PERSONS CIRCULATION AT LEAST EVERY
  15 MINUTES
• KEEP SCISSORS IN YOUR POCKET FOR EMERGENCY
  RELEASE
• REMOVE THE RESTRAINTS EVERY 2 HOURS

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CHECK FOR TIGHTNESS
YOU SHOULD BE ABLE TO INSERT YOUR HAND BETWEEN
THE PATIENT AND THE RESTRAINT
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TYPES OF RESTRAINTS
JACKET
LIMB
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THE OPENING OF THE JACKET RESTRAINT IS ALWAYS
PLACED IN THE FRONT. THIS ALLOWS THE PERSON SOME
FREEDOM OF MOVEMENT
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A MITT RESTRAINT IS USED TO PREVENT THE PERSON
FROM PULLING ON TUBINGS OR DRESSINGS.
CHECK THE RESTRAINT EVERY 15 MINUTES TO MAKE SURE
IT DOES NOT INTERFERE WITH CIRCULATION. YOU
SHOULD BE ABLE TO INSERT TWO FINGERS BETWEEN THE
RESTRAINT AND THE PATIENTS LIMB.
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A HAND ROLL SHOULD BE PLACED UNDER THE PERSONS
FINGERS WHEN USING A MITT RESTRAINT TO KEEP THE
FINGERS IN PROPER POSITION
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REPORTING AND RECORDING

• RECORD THE TYPE OF RESTRAINT BEING APPLIED
• THE BODY PART RESTRAINED
• THE REASON FOR THE APPLICATION
• SAFETY MEASURES TAKEN ( PADDED BED RAILS, BED
  RAILS UP )
• THE TIME YOU APPLIED THE RESTRAINT
• THE TIME YOU REMOVED THE RESTRAINT
• THE CARE GIVEN WHEN THE RESTAINT WAS REMOVED
• SKIN COLOR AND CONDITION
• THE PULSE FELT IN THE RESTRAINED PART
• CHANGES IN THE PERSONS BEHAVIOR
• COMPLAINTS OF PAIN OR DISCOMFORT CAUSED BY THE
  RESTRAINT