1. Medical Restraints

2. Purpose Medical Surgical restraints should be used to create a physical and cultural environment promoting comfort, safety, and the security of patients and others. Restraints should never be used for punishment, or the convenience of staff or other individuals, or as a substitute for effective treatment.

3. Intent for Restraints Utilize alternative to restraints – less invasive, and less restrictive measure Limit the use of restraints - to assist in the care of the patient and protect the health and safety of the patient Document assessments, efforts, and care Assure the patients rights are preserved at all times

4. Definitions Physical Restraint Standard – The direct application of physical force to a patient with or without the patient’s permission to restrict his/her freedom of movement. The physical force may be human, mechanical devices or combination thereof. (JCAHO)

5. Definitions Restraint – Any method (chemical or physical) of restricting a patient's freedom of movement, including seclusion, physical activity, or normal access to his or her body that (1) is not a usual and customary part of a medical diagnostic or treatment procedure to which the patient or his or her legal representative has consented; (2) is not indicated to treat the patient’s medical condition or symptoms; or (3) does not promote the patient’s independent functioning. (JCAHO)

6. Definitions Alternative to restraints –Allow for a patient’s behavior without restriction of movement Forensic and correctional restraints –Forensic staff will be responsible for the initiative and release of restraints for individuals requiring law enforcement restraint

7. Definitions Emergency situations –All measures must be taken to protect the patient from bodily injury to themselves and others

8. When to Use Restraints The decision to use restraints is driven not by diagnosis, but by comprehensive individual assessment that concludes that for this patient, at this time, the use of less intrusive measures pose a great risk than the risk of using a restraint. (HCFA- Hospital Conditions of Participation for Patients’ Rights)

9. Alternatives to Restraints Alternative methods –Diversional activities – TV, radio, reading, games, ambulation –Provide information to alleviate fear –Interaction by family member, child life or volunteers –Collaborate with medical staff to change treatment plan if indicated –Environmental changes – reduce noise, call light with in reach, change lighting within room

10. Alternatives to Restraints Alternative methods –Include patient and parents in treatment plan –Move patient close to nurses station –Explain all procedures to alleviate fear –Provide reality orientation –Use relaxation techniques

11. Restraints do not Include Adaptive support –Devices used to modify the environment to assist in the individual’s care Protection of Therapeutic Devices –All techniques used to protect therapeutic devices such as IV, endotrachial tubes Treatment plan –All devices used to reduce movement during a procedures – medical, dental, diagnostic, or surgical

12. Criteria for Restraint Physician order required Assessment of patient to determine the clinical need –Cognitive deficiency –Patient interfering with treatment

13. Physician Order Must Include Reason for restraint –Combative, self harm, injury to others Type of restraint –Vest, Ankle, or Wrist Date, time, and maximum length of time –PRN orders are NOT allowed

14. Physician Order Verbal order can be obtained if the physician is not readily available Licensed Independent Practitioner (LIP) must sign, time, and date the order within 24 hours of time order is issued New order is required if restraint is off greater than 24 hours

15. Protect the Patient’s Rights The rights of the individual –Right to privacy –Personal dignity –Well being –Protection from psychological harm must be preserved during the use of restraints.

16. Monitor – Document at least every 2 hours Circulation Skin color Respiration Fluids Nourishment Toileting Range of motion – at least 5 minutes for every hour in restraints Mental status Behavior

17. Termination of Restraints Restraints may be removed after the physician or the RN assesses the patient and determines that the criteria for removal has been met.