Transcript Restraints

Restraints
What are Restraints?
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Restraints are
physical, chemical or
environmental
measures used to
control the physical
or behavioural
activity of a person
or a portion of
his/her body.
Laws
Policies of the Ministry of Health and Long-Term Care
that are binding on long-term-care facilities
Statutes and regulations of Ontario that govern the
use of restraints in facilities (the Charitable Institutions
Act, the Nursing Home Act, the Homes for the Aged and
Rest Homes Act)
The common law, which includes among various civil
wrongs the torts of battery, assault and false
imprisonment
The Criminal Code of Canada, which includes criminal
offences.
The Canadian Constitution, which includes the
Canadian Charter of Rights and Freedoms.
Risks of Restraints
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Falls
Strangulation
Loss of Muscle tone
Pressure sores
Decreased mobility
Agitation
Reduced bone mass
Stiffness
Frustration
Loss of Dignity
Incontinence
Constipation
Risk without Restraints
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Falls
Safety of self and others
Kensington Gardens Policy
The Home
practices a
philosophy of
Least
Restraint.
Who? What? Why? How? When?
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Least restraint means all possible alternative
interventions are exhausted before deciding
to use a restraint.
This requires assessment and analysis of
what is causing the behaviour. All behaviour
has meaning. When the reason for the
behaviour is identified, interventions can be
planned to resolve whatever difficulty the
resident is having that contributes to the
consideration of restraint use.
Kensington Gardens Policy
Restraint
Assessment
Form must be
completed
prior to initial
application of
the restraint.
Assessment Tools
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Behavioural Map
Aggressive Behaviour
Risk Assessment
Cohen-Mansfield Agitation
Inventory
Continence Assessment
TENA incontinence product
evaluation
Environmental
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Improved or altered lighting
Path cleared in resident's
room/on unit
Cloth barrier across doorway
Comfortable room
temperature
Privacy and dignity
Environment personalized
Wanderguard applied
Moved to secure unit
Night light
Safety
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Positioning of pillows
Bed height lowered
Call bell within easy reach
Bed, Chair or Seatbelt
Alarm
Side rails
Floor pad beside bed
Toileting and Continence
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Individualized toileting
routine
Product change
Identify bathroom using
signs/symbols
Commode at bedside
Urinal at bedside
Direct Care
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One to one supervision/support
Medical conditions, i.e. infections
Individualized daily routine
Move resident closer to RHA Infomation
Centre
Facilitate rest periods
Limit time spent in bed
Direct Care Continued
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Apply glasses and/or hearing
aides
Use ambulatory aides as per
Care Plan
Evaluate medical
interventions i.e. catheter,
feeding tube
Provide cues during
care/activities
Physiological Interventions
Treatment of the
underlying pathology, i.e.
medication ordered
Pain management
Medication review
Psychological
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Companionship
Active listening
Increase family/friends visiting
Consistent staffing
Encourage staff one to one activities
Familiarization with the environment
Behaviour management intervention
Alter sensory stimulation
Remove to a quiet area
Relaxation techniques
Life Enhancement & Programs
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Teach safe transfer techniques to
resident/family/responsible party
Walking and exercise programs
Incorporate exercise into daily plan of
care
Meaningful individual and/or group
activities
Music therapy
PT/OT consult
Nutritional Care
Provide adequate
fluid/nutritional
intake
Adapt provision of
nutrition to resident's
condition, i.e. finger
food, frequent small
meals, etc.
Dietitian Consult
Referrals
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Attending Physician
Social Worker
Psycho-Geriatric Team
Gerontologist
External Therapeutic
Assessment Program i.e.
Toronto Rehab
Seating and Positioning
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High back or
supportive chair
Individualized
seating
Chair tilt
mechanism
Positioning in a
Wheelchair
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Hips
Level and positioned at the back of the seat
Upper Legs
Supported on the cushion to three (3) inches
behind the knee
Feet
Resting on the footrests
Back
Against the back of the cushion
Positioning in a
Wheelchair
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Headrest
Must be on wheelchair and positioned when
chair is tilted
Use of tilt
Change tilt position many times throughout
the day
Padded Leg Slings
Loose to allow legs to rest back when in tilt
Things that Interfere with
Good Positioning
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Cushion Check- air amount, gel quality,
wrong way, upside down, pommel
Medical- hip flexion restriction, back
pain back kyphosis, scoliosis
Pads and transfer slings on top of
cushion
Improper Positioning
Falls to the side or forward
 Slides out of the wheelchair
 Redness on pressure areas
 Discomfort
 Unable to self propel with hands or
feet
 Unable to engage in functional
activity
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Pressure Areas
Seating Cushion Materials
Foams- Pommel at the front of the
cushion
 Fluid Gels- Must be kneaded properly
after each use
 Roho Cushion- Ensure right amount of
air
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Roho Cushion
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Correct amount: the
cushion looks ¾ full
When pressure is placed
on the cushion, then
released, the cushion
regains its shape
Too Much Air: All cells are
visible, the cushion is
hard, unstable and looks
too large for the
wheelchair
Restraint Deemed Necessary
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The Least Restrictive is Used
Consent
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The decision to
apply a restraint
involves the
resident and/or his
family/substitute
decision-maker.
Documentation
shows thorough
assessment of the
need for a
restraint, including
ALL alternate
measures
attempted
Doctor’s Order
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Restraint is applied
on written order (or
a telephone order
which is cosigned)
of a Physician who
has attended the
resident and
approved the type
of restraint.
Approved Restraints
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Wheelchair tray
Rear facing seatbelts
Lap restraint
Mitt restraint
Self limiting seat belt
(resident cannot undo
without assistance)
How Often do I check?
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The resident is
checked at a
minimum of hourly
and repositioned
at a minimum of
every two hours
while restrained.
Documentation
Document on the Restraint Monitoring
Record.
Proper Application of Seatbelts
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ONLY FASTEN THE
SEAT BELT IF &
WHEN REQUIRED
MAKE SURE THE
SEAT BELT IS IN
GOOD CONDITION
Compare to a Car Seatbelt
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CHECK THAT THE SEAT
BELT IS TIGHTENED
APPROPRIATELY
Place one flat hand
between belt and
resident
Too Loose is
Dangerous
Position at the hips not
the abdomen
NO Twisting
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Ensure the belt is not
twisted
Do not tie belt around
arm of chair
If seatbelt is too long
inform Shopper’s Home
Health
Reassessment
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The need for continuing use of
the restraint is reassessed
within 12 hours and the
Restraint Monitoring record
signed at the bottom by the
Registered staff to indicate the
continued need past twelve
hours
Registered staff are also
required to reassess restraint
quarterly
Questions?
The End!!!
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Thank-you
for Coming