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Page 1: Use of restraint

USE of RESTRAINTUSE of RESTRAINT

Page 2: Use of restraint

DefinitionDefinitionAny action or deed that is used for the Any action or deed that is used for the

purpose or intent of restricting the free purpose or intent of restricting the free movement or decision making abilities of movement or decision making abilities of another person; as such it may constitute another person; as such it may constitute an imposition on a person’s rights and an imposition on a person’s rights and dignity.dignity.

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CONTCONT• Restraint consist of any physical or Restraint consist of any physical or

chemical restraint used on a patient to keep chemical 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 therapeutic Is used only as an emergency therapeutic measure and only where no other option is measure and only where no other option is available.available.

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Package

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Arguments for the use of RestraintArguments for the use of Restraint

11 . .EthicalEthical

22 . .BeneficenceBeneficence

33 . .ProfessionalProfessional

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Statement of Statement of AccountabilityAccountability•Physician- responsible for writing Physician- responsible for writing

and reviewing the restraint order.and reviewing the restraint order.•Responsible nurse- responsible for Responsible nurse- responsible for

assessment and documentationassessment and documentation•Head nurse- responsible for Head nurse- responsible for

monitoring the policy fully monitoring the policy fully implemented.implemented.

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Order for Order for RestraintRestraint

•Use only after written order by the Use only after written order by the physician, unless emergency physician, unless emergency situation occurs.situation occurs.

•Patient is reassessed every 24 Patient is reassessed every 24 hours for continued need for hours for continued need for restraint.restraint.

•New order is required after 24 New order is required after 24 hours.hours.

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CONTCONT……

•No standing order allowedNo standing order allowed•Physician and nurse must Physician and nurse must

document in their notes the document in their notes the indication for restraint.indication for restraint.

•Type of restraint to be usedType of restraint to be used•The projected time restraint is to The projected time restraint is to

be employedbe employed..

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Alternative for RestraintAlternative for Restraint

• Provide for companionship and supervisionProvide for companionship and supervision• Modify the environmentModify the environment• Provide readily orientation and Provide readily orientation and

psychosocial interventions.psychosocial interventions.• Offer diversionary and physical activitiesOffer diversionary and physical activities• Design creative alternativesDesign creative alternatives

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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 from Geri- chair that restrict the patient from

leaving the chairleaving the chair

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AssessmentAssessment• Check for circulation, condition of limbsCheck for circulation, condition of limbs• Attention should be given to patient’s needs Attention should be given to patient’s needs

including hydration, elimination and including hydration, elimination and nutritionnutrition

• Vital signsVital signs

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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

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How to Apply RestraintHow to Apply Restraint

• Apply restraint according to the Apply restraint according to the manufacturer’s directionsmanufacturer’s directions

• It should be easy to remove in the event of It should be easy to remove in the event of fire and emergenciesfire and emergencies

• Extremity restraints must be attached to the Extremity restraints must be attached to the frame of bed and not to the side rails. Allow frame of bed and not to the side rails. Allow length of strap for acceptable movementslength of strap for acceptable movements

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CONTCONT……• Extremity restraints must be assessed and Extremity restraints must be assessed and

one extremity must be released every 2 one extremity must be released every 2 hours.hours.

• A vest restraint must be applied with at A vest restraint must be applied with at least two fingers space between body and least two fingers space between body and vest.vest.

• Apply restraint in such a manner that does Apply restraint in such a manner that does not restrict circulation.not restrict circulation.

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REMEMBERREMEMBER!!

Protect patient’s Right, Protect patient’s Right, Dignity and Well – beingDignity and Well – being..

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Education of FamilyEducation of Family• Teach/ explain the reason for the restraint, the Teach/ explain the reason for the restraint, the

care that will be provided while restrained and the care 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 nurse’s Restraint may be removed based on the nurse’s assessment of risk when the family is present at assessment of risk when the family is present at the bedside.the bedside.

• Document patient/ family education on Document patient/ family education on appropriate forms.appropriate forms.

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Staff EducationStaff Education• On- going restraint education and On- going restraint education and

training will be provided both as training will be provided both as part of the initial orientation of all part of the initial orientation of all staff who have direct patient care staff who have direct patient care responsibilities.responsibilities.

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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

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Document Release of a Patient Document Release of a Patient from Restraintfrom Restraint

• Restraint should be frequently evaluated and Restraint should be frequently evaluated and ended at the earliest possible time based on the ended at the earliest possible time based on the assessment and re-evaluation of the patient’s assessment and re-evaluation of the patient’s condition.condition.

• Rationale for removing the patient from restraint Rationale for removing the patient from restraint will be documented on the patient’s medical will be documented on the patient’s medical record.record.

• The physician or RN may terminate the restraint The physician or RN may terminate the restraint when in their clinical judgment.when in their clinical judgment.

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CONTCONT……• Reusable restraint cuffs and straps are to be Reusable restraint cuffs and straps are to be

sprayed with disinfectant and wiped after use and sprayed 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 soiled Cloth 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 with Restraint devices should not be sent home with

patient or family.patient or family.

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Thank You!!!Thank You!!!


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