Restraints are any devices used to restrict movement. In nursing homes and hospitals they are used for the patient's safety. However, there is often concern that facilities' staff uses them too often or for the wrong reasons, thus causing harm to the patient.
Types of Restraints
There are many types of restraints available.
Soft belts or safety vests are used to tie a patient to a bed or wheelchair by restricting the torso. A safety bar is a bar placed across the lap of the wheelchair to prevent a patient from falling or sliding out. Wrist or mitt restraints prevent the patient from removing IV tubing or dressings. Bed rails are considered a restraint, and policies vary as to how and when they can be raised.
There are also medications that are considered chemical restraints. These are administered by a nurse or physician, generally as a case of last resort when a patient becomes violent.
Effects of Restraints
Restraints should only be used to protect the patient. Patients may be restrained if they are violent or are in danger of falling, wandering or harming himself or others.
Restricting movement with a restraint may result in:
Loss of personal dignity and self esteem
Increased confusion
Anxiety
Increased Anger
Frustration
Decreased communication
Physically, restraints can result in:
Skin breakdown
Muscle weakness
Blood clots
Pneumonia
Constipation
Alternatives to Restraints
Restraints are generally considered to be a last-resort measure. Before using a restraint try to:
Use bed or door alarms to designate confused patients.
Distract the resident with another activity or television.
Play calming music.
Transport the patient to another area.
Use padding, stuffed animals and other soft items for support.
Speak to the patient in a calm, firm voice.
Restraint Procedure
1. Use the alternative techniques first.
2. Get a doctor's order in writing.
3. Use the least restrictive restraint when possible (that is, use a wrist restraint instead of a vest etc.).
4. Use the correct size restraint.
5. Explain to the resident about the restraint and why it is being applied.
6. Apply the restraint securely and correctly.
7. Allow the patient as much movement as possible; keep the call light within the patient's reach.
8. Check wrist restraints every 15 minutes.
9. Check patient safety every 30 minutes, including checking for skin breakdown, body alignment and toileting needs, and address those needs as needed.
10. Remove the restraints every 2 hours.
11. Exercise the restricted limb.
12. Document the application, checks and removal of the restraints.
Warning
Unnecessary use of restraints is considered false imprisonment. Nursing home staff should never use restraints for their own convenience. State and federal laws, including the Omnibus Budget Reconciliation Act (OBRA), covers the use of restraints.
Learn state and local laws and the nursing home's policies on restraints. Document any violations and discuss any discrepancies with the nursing home's administration. If necessary, report your findings to the local health department or police.
Tips
Reassure the restrained patient frequently. Remove the restraint as soon as you feel the patient's safety risk is gone.
Physical restraints can bruise delicate skin, especially in the elderly. Apply the restraint so that it is secure but does not damage skin.
When attempting to restrain a violent patient, do not grab him. This can be considered assault and charges can be filed against you.
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