Rest r aint s, Secl usion, and Safet y Devices

41 Pages·2014·0.13 MB·English

Rest r ai n t s, Sec l u si o n , an d
Sa f e t y D e v i c e s
Th e fu ll p o licy is lo ca t e d in Po licyTe ch
If yo u h a ve a n y q u e st io n s, co n t a ct :
Sh a n d ra Mit ch e ll, BSN, RN-BC
Ed u ca t io n Co o rd in a t o r
Tra in in g a n d De ve lo p m e n t
Last Updated: 2013-12-18
D ef i n i t i o n
A re st ra in t is d e fin e d a s a m a n u a l m e t h o d , p h ysica l o r
m e ch a n ica l d e vice , m a t e ria l, o r e q u ip m e n t t h a t
im m o bilize s o r re d u ce s t h e a bilit y o f a p a t ie n t t o m o ve
h is o r h e r a rm s, le g s, bo d y, o r h e a d fre e ly; o r a d ru g o r
m e d ica t io n w h e n it is u se d a s a re st rict io n t o co n t ro l t h e
p a t ie n t ’s be h a vio r o r re st rict t h e p a t ie n t ’s fre e d o m o f
m o ve m e n t a n d is n o t a st a n d a rd t re a t m e n t o r d o sa g e fo r
t h e p a t ie n t ’s m e d ica l o r p sych ia t ric co n d it io n .
U se Rest r ai n t s A s A L ast Reso r t !
Re st ra in t s ke e p p a t ie n t s in a ct ive ca u sin g m u scle s a n d
jo in t s t o w e a ke n .
Th is p la ce s p a t ie n t s a t g re a t e r risk fo r in ju rie s like fa lls,
co n t ra ct u re s, p re ssu re so re s, a n d in co n t in e n ce .
Th e y ca n ca u se e m o t io n a l a n d p sych o lo g ica l p ro ble m s
like d e p re ssio n a n d co n fu sio n , a n d ca n e ve n m a ke t h e
p a t ie n t m o re co m ba t ive .
A l t er n at i v es t o Rest r ai n t s
So m e a lt e rn a t ive s t o re st ra in t s in clu d e :
– M onit oring: Ha ve a fa m ily/ frien d sit w it h t h e pa t ien t .
Ma in t a in close, frequ en t observa t ion .
– Environm ent al: At t em pt t o m a ke t h em m ore com fort a ble.
• bed posit ion
• light ing
• decrease noise level
– Com fort m easures: Address a n y pa in or discom fort .
– M edicat ion/ nut rit ion: Provide sn a cks a n d h ydra t ion . Assess
a n d provide PRN m edica t ion .
A l t er n at i v es t o Rest r ai n t s
Ot h e r a lt e rn a t ive s in clu d e :
– Toilet ing: Est a blish a rou t in e a n d respon d prom pt ly.
– Diversion: Redirect t h eir a t t en t ion w it h TV, video, ra dio,
pu zzles, t oys, or rea din g m a t eria l.
– Int erpersonal skills: Use a ct ive list en in g, ca lm rea ssu ra n ce,
et c.
Se e t h e p o licy fo r a m o re d e t a ile d list .
A ssess Yo u r Pat i en t
Alw a ys a sse ss t h e p a t ie n t fo r m e d ica l ca u se s w it h n e w
o n se t o r w o rse n in g be h a vio r p rio r t o re st ra in in g t h e
p a t ie n t (if p o ssible ), a n d a lw a ys w it h in 3 0 m in u t e s o f
in it ia t io n .
Asse ss t h e p a t ie n t fo r t h e fo llo w in g :
– Hypoglycem ia (blood glu cose)
– Hypoxia / Hypot en sion / Dysrh yt h m ia (vit a l sign s, pu lse ox)
– Fever
– Recen t su rgery (pu lm on a ry em bolu s)
– Adm ission for overdose
– Hist ory of a lcoh ol depen den ce
– Recen t fa ll/ h ea d in ju ry
– Assess ba selin e m en t a l st a t u s (dem en t ia / Alzh eim er’s)
Types o f Rest r ai n t D ev i c es
So m e o f t h e t yp e s o f re st ra in t s in clu d e :
– Soft lim b devices
– Rigid lim b devices
– Im m obilizers (pedia t rics n o-n o’s in clu ded)
– Vest s
– Mit t en s
– En closu re bed
– Side ra ils (depen din g on in t en t )
Types o f Rest r ai n t D ev i c es
So m e o f t h e t yp e s o f re st ra in t s in clu d e :
– Ch em ica ls/ Medica t ion s (w it h specifica t ion s)
– Th era peu t ic Hold
– Seclu sion (Beh a viora l Hea lt h m et h od)
– Tim e Ou t (Beh a viora l Hea lt h m et h od)
– Geri ch a ir
T i es f o r so f t l i mb, v est , an d
m i t t e n s
Tie so ft lim b re st ra in t s, ve st s, a n d m it t e n s u sin g a q u ick
re le a se kn o t (slip kn o t ).
Se cu re t h e kn o t o u t o f t h e p a t ie n t ’s re a ch a n d a w a y fro m
m o vin g p a rt s like t h e be d ra il, w h e e ls, o r bra ke o f
w h e e lch a ir.
Do not secure t ies t o shoulder loops of vest or t ie t o head
of bed.
Ch ec k i n g f o r ac c u r at e f i t
Ma ke su re yo u u se t h e a p p ro p ria t e t e ch n iq u e t o ch e ck fo r
a n a ccu ra t e fit :
– Soft lim b: on ly 2 fin gers sh ou ld fit bet w een device a n d
pa t ien t ’s skin .
– Im m obilizer: 2 sizes a va ila ble – sm a ll for a rm a n d lon ger for
leg. Ch eck for a dequ a t e dist a l pu lse a n d ca pilla ry refill.
– Vest : color coded ba sed on size/ w eigh t . On ly 2 fin gers sh ou ld
fit a t w a ist bet w een device a n d pa t ien t .
– M it t en: on ly 2 fin gers sh ou ld fit bet w een cu ff a n d pa t ien t ’s
skin .