Transcript Restraint & Seclusion: Review and Update

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2012
Restraints Module for LIPs
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Hospital Philosophy on Restraint Use
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Restraints are limited to those situations where there is appropriate
clinical justification
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Restraints will be selected when alternative interventions have been
attempted and determined to be ineffective to protect the patient and/or
others from harm
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The staff will employ the least restrictive method of physical restraint for
the shortest possible duration
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Restraints will be used for medical necessity only and not as a means
of coercion, discipline, convenience, or retaliation
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Residents are permitted to order restraints once education has been
completed under the rules of the GME program
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Definition of Restraint
• Physical Restraint
– Any manual method or physical or mechanical device, material
or equipment
• Attached or adjacent to the patient’s body
• That he or she cannot easily remove
• That restricts freedom of movement or normal access to
patient’s body
– Includes use of side rails intended to prevent patient
exit from the bed
• Chemical Restraint
– A drug or medication when it is used as a restriction to manage
the patient’s behavior or restrict the patient’s freedom of
movement and is not a standard treatment or dosage for the
patients condition.
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Definition of Seclusion
• Seclusion
– Is the involuntary confinement of a person in a
room or an area where the person is physically
prevented from leaving
– May only be used for the management of violent
or self-destructive behavior that jeopardizes the
immediate physical safety of the patient, a staff
member or others.
Is only used in DMC and ER
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Restraint Categories
• Type of category is determined by the SITUATION that
the restraint is being used to address NOT the
diagnosis or treatment setting
• Non-Violent/Non-Self-Destructive
– Used to promote medical/surgical healing (removing
tubes, lines or wandering)
– Non-violent and non-self-destructive
• Violent/Self-Destructive
– Emergency measure
– Violent and/or self-destructive behavior that jeopardizes
the immediate physical safety of the patient, staff or
others.
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Orders
• No standing or prn orders
• Must be on Restraint Order Sheet
Non Violent/
Non-self-destructive
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Violent/self-destructive
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Non Violent/ Non-Self-Destructive Restraints
• Initiation
– RN will notify LIP and obtain written/telephone order
• Within 12 hours of initiation
• Immediately, if based on significant change in patient’s
condition
– LIP will sign order based on physical exam on Restraint Order
Form within 24 hours of restraint initiation
• Continuation
– A new Restraint Order Sheet must be completed at least every 24
hours (cannot exceed 24 hours) AND is based upon an
examination of the patient by the LIP.
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Key Point
• Restraints for behavior that appears violent or
self-destructive that is triggered by a medical
condition still fall under the category of “NonViolent/Non-Self-Destructive” restraints.
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Restraint for Violent/Self-Destructive Behavior
• A face to face evaluation must occur in 1 hour
– For inpatients, the DMC RN supervisor may perform
this evaluation instead of the LIP
• A new order is required more frequently
• Time limits for orders based on age
– Four hours for 18 years of age and older.
– Two hours for ages 9-17
– One hour age 9 and younger
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Restraint for Violent/Self-Destructive Behavior
• Continuation
• Alternating RN telephone order from
LIP/Physician and face-to-face LIP evaluation.
– If V/SD Restraints are still required for an
adult patient after 4 hours, the RN can get
a telephone order.
– If they are still required 4 hours later (the
patient has now been in restraints for 8
hours), the LIP/Physician must now come in
to perform the face-to-face evaluation.
– It should be VERY unusual to have V/SD
restraints in adult or pediatric units for this
length of time.
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Discontinuation of Restraints
• Restraints will be removed when:
– Reason for restraint is no longer present
– Alternative strategies become successful
– Reassessment indicates reason for use of
restraint no longer applies
– Upon physician order
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Reapplication of Restraints
• If the restraint is discontinued prior to
expiration of the original order, and
re-initiation of restraint is indicated, a new
order must be obtained and the standards
restarted.
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Key Points & Summary
• Remember, restraints DO NOT PREVENT FALLS or
pulling on tubes or medical devices
• Always try least restrictive methods before actual
restraints are employed.
• The Order Set must be used
– The Order Sets contain the required elements of
documentation for the LIP
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Thank You
• We hope this computer-based learning course has
been both informative and helpful
• Click the Take Test button on the left side when you
are ready to complete the requirements for this
course. A passing score is 90%.
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