1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 12 Restraint Alternatives and Safe Restraint Use

2. Slide 2 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. 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.

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  HISTORY OF RESTRAINT USE  Until the late 1980s, restraints were thought to prevent falls. Research shows that restraints cause falls. Research shows that restraints cause falls. Injuries are more serious from falls in restrained persons. 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. They can cause serious harm, even death.

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. They require trying all other appropriate alternatives first.  Every center has policies and procedures about restraint use.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  RESTRAINT ALTERNATIVES  Often there are causes and reasons for harmful behaviors. Knowing and treating the cause can prevent restraint use. Knowing and treating the cause can prevent restraint use. Restraint alternatives for the person are identified. Restraint alternatives for the person are identified. Restraint alternatives become part of the care plan. Restraint alternatives become part of the care plan. It restraint alternatives do not protect the person, the doctor may need to order restraints. It restraint alternatives do not protect the person, the doctor may need to order restraints.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  SAFE RESTRAINT USE  Restraints can cause serious injury and even death.  Centers must follow: OBRA guidelines OBRA guidelines CMS guidelines CMS guidelines FDA guidelines FDA guidelines Accrediting agency guidelines Accrediting agency guidelines State laws State laws  Restraints are not used to discipline a person or for staff convenience.

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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. Sometimes restraints are needed to protect the person or others.  Physical restraint May be any manual method, physical or mechanical device, material, or equipment May be any manual method, physical or mechanical device, material, or equipment Is attached to or next to the person’s body Is attached to or next to the person’s body Restricts freedom of movement or access to one’s body Restricts freedom of movement or access to one’s body Cannot be easily removed by the person. Cannot be easily removed by the person.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Drugs are restraints if they: Control behavior or restrict movement Control behavior or restrict movement Are not standard treatment for the person’s condition 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 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. Injuries occur from using the wrong restraint, applying it wrong, or keeping it on too long. The most serious risk is death from strangulation. The most serious risk is death from strangulation. There are also mental effects. There are also mental effects.

9. Slide 9 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Restraints are medical devices. The Safe Medical Device Act applies if a restraint causes illness, injury, or death. 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. CMS requires the reporting of any death that occurs while a person is in restraints.  Legal aspects Restraints must protect the person. Restraints must protect the person. A written doctor’s order is required. A written doctor’s order is required. The least restrictive method is used. The least restrictive method is used. Restraints are used only after other measures fail to protect the person. Restraints are used only after other measures fail to protect the person. Unnecessary restraint is false imprisonment. Unnecessary restraint is false imprisonment. Informed consent is required. Informed consent is required.

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Safety guidelines Observe for increased confusion and agitation. Observe for increased confusion and agitation. Protect the person’s quality of life. Protect the person’s quality of life. Follow the manufacturer’s instructions. Follow the manufacturer’s instructions. Apply restraints with enough help to protect the person and staff from injury. 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. 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. Remove the restraint, reposition the person, and meet basic needs at least every 2 hours. Follow the care plan. Follow the care plan.

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Report and record the following: The type of restraint applied The type of restraint applied The body part or parts restrained The body part or parts restrained The reason for the application The reason for the application Safety measures taken Safety measures taken The time you applied the restraint The time you applied the restraint The time you removed the restraint The time you removed the restraint The care given when the restraint was removed The care given when the restraint was removed Skin color and condition Skin color and condition The pulse felt in the restrained part The pulse felt in the restrained part Changes in the person’s behavior 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). Complaints of a tight restraint; difficulty breathing; and pain, numbness, or tingling in the restrained part (report these complaints to the nurse at once).

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Applying restraints Restraints are made of cloth or leather. Restraints are made of cloth or leather. Restraints may increase confusion and agitation in persons with dementia. Restraints may increase confusion and agitation in persons with dementia. Never use force to apply a restraint. Never use force to apply a restraint. Ask a co-worker to help apply the restraint if needed. Ask a co-worker to help apply the restraint if needed. Report problems to the nurse at once. Report problems to the nurse at once. Wrist restraints (limb holders) limit arm movement. Wrist restraints (limb holders) limit arm movement. Hands are placed in mitt restraints. Hands are placed in mitt restraints. Belt restraints are used when injuries from falls are risks. Belt restraints are used when injuries from falls are risks.

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Vest restraints and jacket restraints are applied to the chest. Vest restraints and jacket restraints are applied to the chest. A jacket restraint is applied with the opening in the back. A jacket restraint is applied with the opening in the back. For a vest restraint, the vest crosses in front. For a vest restraint, the vest crosses in front. The straps of vest and jacket restraints: 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. You are advised to only assist the nurse in applying vest and jacket restraints.  Death can occur from strangulation.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  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 Providing for comfort Meeting safety and security needs Meeting safety and security needs Promoting independence Promoting independence Allowing personal choice Allowing personal choice