Transcript Slide 1
Chapter 14 Restraint Alternatives and Safe Restraint Use Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Some persons need extra protection. • Every attempt is made to protect the person without using restraints. Restraints are used only as a last resort to protect persons from harming themselves or others. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2 HISTORY OF RESTRAINT USE Until the late 1980s, restraints were thought to prevent falls. • Research shows that restraints cause falls. • Injuries are more serious from falls in restrained persons. Older persons were restrained more often than younger persons were. Their purpose was to protect a person. • They can cause serious harm, even death. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3 OBRA, the Centers for Medicare & Medicaid Services (CMS), the U.S. Food and Drug Administration (FDA), state laws, and accrediting agencies have guidelines about restraint use. • They require trying all other appropriate alternatives first. Every center has policies and procedures about restraint use. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4 RESTRAINT ALTERNATIVES Often there are causes and reasons for harmful behaviors. • Knowing and treating the cause can prevent restraint use. • Restraint alternatives for the person are identified. • Restraint alternatives become part of the care plan. • It restraint alternatives do not protect the person, the doctor may need to order restraints. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5 SAFE RESTRAINT USE Restraints can cause serious injury and even death. Centers must follow: • OBRA guidelines • CMS guidelines • FDA guidelines • Accrediting agency guidelines • State laws Restraints are not used to discipline a person or for staff convenience. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6 According to OBRA, restraints are used only when necessary to treat a person’s medical symptoms. • Sometimes restraints are needed to protect the person or others. Physical restraint • May be any manual method, physical or mechanical device, material, or equipment • Is attached to or next to the person’s body • Restricts freedom of movement or access to one’s body • Cannot be easily removed by the person. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7 Drugs are restraints if they: • Control behavior or restrict movement • Are not standard treatment for the person’s condition Complications of restraint use are many. • Injuries occur as the person tries to get free of the restraint. • Injuries occur from using the wrong restraint, applying it wrong, or keeping it on too long. • The most serious risk is death from strangulation. • There are also mental effects. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8 Restraints are medical devices. • The Safe Medical Device Act applies if a restraint causes illness, injury, or death. • CMS requires the reporting of any death that occurs while a person is in restraints. Legal aspects • Restraints must protect the person. • A written doctor’s order is required. • The least restrictive method is used. • Restraints are used only after other measures fail to protect the person. • Unnecessary restraint is false imprisonment. • Informed consent is required. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 Safety guidelines • Observe for increased confusion and agitation. • Protect the person’s quality of life. • Follow the manufacturer’s instructions. • Apply restraints with enough help to protect the person and staff from injury. • Observe the person at least every 15 minutes or more often as required by the care plan. • Remove the restraint, reposition the person, and meet basic needs at least every 2 hours. • Follow the care plan. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10 Report and record the following: • The type of restraint applied • The body part or parts restrained • The reason for the application • Safety measures taken • The time you applied the restraint • The time you removed the restraint • The care given when the restraint was removed • Skin color and condition • The pulse felt in the restrained part • Changes in the person’s behavior • Complaints of a tight restraint; difficulty breathing; and pain, numbness, or tingling in the restrained part (report these complaints to the nurse at once). Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11 Applying restraints • Restraints are made of cloth or leather. • Restraints may increase confusion and agitation in • • • • • • persons with dementia. Never use force to apply a restraint. Ask a co-worker to help apply the restraint if needed. Report problems to the nurse at once. Wrist restraints (limb holders) limit arm movement. Hands are placed in mitt restraints. Belt restraints are used when injuries from falls are risks. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12 • Vest restraints and jacket restraints are applied to the chest. • A jacket restraint is applied with the opening in the back. • For a vest restraint, the vest crosses in front. • The straps of vest and jacket restraints: Always cross in the front Never cross in the back Are always applied over a garment Have life-threatening risks • You are advised to only assist the nurse in applying vest and jacket restraints. Death can occur from strangulation. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13 QUALITY OF LIFE Restraints lessen the person’s dignity. The restrained person depends on others for basic needs. You can promote quality of life by: • Providing for comfort • Meeting safety and security needs • Promoting independence • Allowing personal choice Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14