USE of RESTRAINTUSE of RESTRAINTUSE of RESTRAINTUSE of RESTRAINT
DefinitionDefinition Any action or deed that is used for theAny action or deed that is used for the purpose or intent of restricting the freepurpose or intent of restricting the free movement or decision making abilities ofmovement or decision making abilities of another person; as such it may constituteanother person; as such it may constitute an imposition on a persons rights andan imposition on a persons rights and dignity.dignity.
CONTCONT Restraint consist of any physical orRestraint consist of any physical or chemical restraint used on a patient to keepchemical restraint used on a patient to keep him from causing harm to self or to others.him from causing harm to self or to others. Is used only as an emergency therapeuticIs used only as an emergency therapeutic measure and only where no other option ismeasure and only where no other option is available.available.
Arguments for the use of RestraintArguments for the use of Restraint 11..EthicalEthical 22..BeneficenceBeneficence 33..ProfessionalProfessional
Statement ofStatement of AccountabilityAccountability Physician- responsible for writingPhysician- responsible for writing and reviewing the restraint order.and reviewing the restraint order. Responsible nurse- responsible forResponsible nurse- responsible for assessment and documentationassessment and documentation Head nurse- responsible forHead nurse- responsible for monitoring the policy fullymonitoring the policy fully implemented.implemented.
Order for RestraintOrder for Restraint Use only after written order by theUse only after written order by the physician, unless emergencyphysician, unless emergency situation occurs.situation occurs. Patient is reassessed every 24 hoursPatient is reassessed every 24 hours for continued need for restraint.for continued need for restraint. New order is required after 24New order is required after 24 hours.hours.
CONTCONT No standing order allowedNo standing order allowed Physician and nurse must documentPhysician and nurse must document in their notes the indication forin their notes the indication for restraint.restraint. Type of restraint to be usedType of restraint to be used The projected time restraint is to beThe projected time restraint is to be employedemployed..
Alternative for RestraintAlternative for Restraint Provide for companionship and supervisionProvide for companionship and supervision Modify the environmentModify the environment Provide readily orientation andProvide readily orientation and psychosocial interventions.psychosocial interventions. Offer diversionary and physical activitiesOffer diversionary and physical activities Design creative alternativesDesign creative alternatives
Restraint TypeRestraint Type Soft wrist restraintSoft wrist restraint Soft ankle restraintSoft ankle restraint Velcro wrist restraintVelcro wrist restraint Velcro ankle restraintVelcro ankle restraint Posey vestPosey vest Geri- chair that restrict the patient fromGeri- chair that restrict the patient from leaving the chairleaving the chair
AssessmentAssessment Check for circulation, condition of limbsCheck for circulation, condition of limbs Attention should be given to patients needsAttention should be given to patients needs including hydration, elimination andincluding hydration, elimination and nutritionnutrition Vital signsVital signs
Behavior Required for ReleaseBehavior Required for Release Follows instructions, directionsFollows instructions, directions Calm, in controlCalm, in control Verbal contactVerbal contact Asks for assistanceAsks for assistance
How to Apply RestraintHow to Apply Restraint Apply restraint according to theApply restraint according to the manufacturers directionsmanufacturers directions It should be easy to remove in the event ofIt should be easy to remove in the event of fire and emergenciesfire and emergencies Extremity restraints must be attached toExtremity restraints must be attached to the frame of bed and not to the side rails.the frame of bed and not to the side rails. Allow length of strap for acceptableAllow length of strap for acceptable movementsmovements
CONTCONT Extremity restraints must be assessed andExtremity restraints must be assessed and one extremity must be released every 2one extremity must be released every 2 hours.hours. A vest restraint must be applied with atA vest restraint must be applied with at least two fingers space between body andleast two fingers space between body and vest.vest. Apply restraint in such a manner that doesApply restraint in such a manner that does not restrict circulation.not restrict circulation.
REMEMBERREMEMBER!! Protect patients Right,Protect patients Right, Dignity and Well beingDignity and Well being..
Education of FamilyEducation of Family Teach/ explain the reason for the restraint, theTeach/ explain the reason for the restraint, the care that will be provided while restrained and thecare that will be provided while restrained and the criteria for the removal of the restraint.criteria for the removal of the restraint. Restraint may be removed based on the nursesRestraint may be removed based on the nurses assessment of risk when the family is present atassessment of risk when the family is present at the bedside.the bedside. Document patient/ family education onDocument patient/ family education on appropriate forms.appropriate forms.
Staff EducationStaff Education On- going restraint education andOn- going restraint education and training will be provided both astraining will be provided both as part of the initial orientation of allpart of the initial orientation of all staff who have direct patient carestaff who have direct patient care responsibilities.responsibilities.
DocumentationsDocumentations Fill Restraint Form.Fill Restraint Form. Date and time restraint is initiatedDate and time restraint is initiated Date of assessmentDate of assessment Reason for restraintReason for restraint Alternative methods attempted prior to restraintAlternative methods attempted prior to restraint Attempts to discontinue restraintAttempts to discontinue restraint Date and time restraint is discontinuedDate and time restraint is discontinued
Document Release of a PatientDocument Release of a Patient from Restraintfrom Restraint Restraint should be frequently evaluated andRestraint should be frequently evaluated and ended at the earliest possible time based on theended at the earliest possible time based on the assessment and re-evaluation of the patientsassessment and re-evaluation of the patients condition.condition. Rationale for removing the patient from restraintRationale for removing the patient from restraint will be documented on the patients medicalwill be documented on the patients medical record.record. The physician or RN may terminate the restraintThe physician or RN may terminate the restraint when in their clinical judgment.when in their clinical judgment.
CONTCONT Reusable restraint cuffs and straps are to beReusable restraint cuffs and straps are to be sprayed with disinfectant and wiped after use andsprayed with disinfectant and wiped after use and before storage in the linen room.before storage in the linen room. Cloth restraint devices will be placed in soiledCloth restraint devices will be placed in soiled linen hampers after use.linen hampers after use. Disposable restraint will be discarded.Disposable restraint will be discarded. Restraint devices should not be sent home withRestraint devices should not be sent home with patient or family.patient or family.