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The Use of Restraints and Physical Therapy . By Dymond Unutoa. Objectives. Understand the definitions of Restraint Understand Restraint purposes Recognize Types of Restraints Know possible Alternatives before Restraining Understand the process of Restrain Application

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Presentation Transcript
objectives
Objectives
  • Understand the definitions of Restraint
  • Understand Restraint purposes
  • Recognize Types of Restraints
  • Know possible Alternatives before Restraining
  • Understand the process of Restrain Application
  • Recognize Complications with Restraint use
  • Understand how Physical Therapy can be Involved
  • Recognize Non-Restraints
definition of restraint
Definition of Restraint
  • 1) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely; or
  • 2) A drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition
purpose
Purpose
  • Protection from self and others upon display of violent and unsafe behavior in environment/situation
  • Care management for a patient who exhibits behavior that is interfering with POC or intervention (i.e. pull on tube/IV)
use justification
Use Justification

NON-Violent or

NON-Self Destructive

Violent/Self Destructive

  • Pulling at Invasive Tubes or Lines
  • Patient safety – Attempts to leave bed when exhibiting disorientated/confused behavior with potential injury to self
  • Interruption of surgical/wound maintenance (picks at site)
  • Emergency Behavioral Situation – Physically aggressive with significant potential to harm self or others
types of restraint
Types of Restraint
  • Sitter
  • Wrist/Ankle Soft
  • Wrist/Ankle Leather
  • Posey Vest
  • Mitt
  • All 4 side rails engaged
  • Belts
types continued
Types Continued
  • Chemical- Tranquilizers – Decrease agitation in acutely psychotic patients- Benzodiazepines (Valium)

- Lorazepam – Elderly, long duration

- Midazolam – Rapid sedation, short duration

considerations
Considerations
  • Alternatives
  • Preserving patient rights and dignity
  • Safe application
  • Environment – Their access to surroundings
  • Patient’s ability to participate in POC
  • Risks associated – Behavior, child, cognitive
alternatives to restraint
Alternatives to Restraint
  • Encouragement for family involvement
  • Patient location in relation to staff
  • Position of patient bed
  • Use of Call bell
  • Bed/Exit Alarms
  • Reorient patient to environment
  • Conceal IV/Tube sites
application
Application
  • Assessment for restraint use performed by RN
  • Physician or LIP that’s authorized to elicit restraint use can do so as per hospital policy
  • Checked every 15 min
  • Orders in writing
  • Orders must not exceed 24 hrs
complications
Complications
  • Injury – Abrasions and Bruises

*Inappropriate application can lead to serious injury

  • Pressure sores
  • Circulation disruption
  • Loss of gag reflex - Sedation
  • DEATH
pt involvement
PT Involvement
  • Collaborate with on-care nurse.
  • Patient education
  • Assessment of potential physiological outcomes
  • Orientation – Psychological/Cognitive patients
  • Intervention planning and POC
  • Family education
non restraint devices
Non-Restraint Devices
  • Orthopedically prescribed devises
  • Surgical dressings
  • Bandages
  • Any device that can be manually removed by patient in same manner as applied.
thought
Thought…
  • Does knowledge without action become neglect?

– Safe Patient Handling

references
References
  • IASIS Health Care Risk Management Manual. Origination (9/28/08). Restraint and Seclusion (Section: Clinical Risk Policy Number: RMCO.011)
  • MedCEU Restraint Continuing Education Course. http://www.medceu.com/index/index.php?page=get_course&courseID=3631&nocheck. Accessed November 17, 2012
  • Haut A, Kolbe N, Strupeit S, Mayer H, Meyer G. Attitudes of Relative of Nursing Home Residents Toward Physical Restraints. Journal of Nursing Scholarship [serial online]. 2010;42:4,448-456
  • Williams D. Restraint Safety: an Analysis of Injuries Related to Restraint of People with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities [serial online]. 2009;22:135-139.
  • Wilson C, Klein A, Kirsch N (Michigan Chapter). Proposal RC 29-12 – The Role of PT in patient handling. Adopted June 2012 in House of Delegates to APTA.
  • Gulpers M, Bleijlevens M, Ambergen T et al. Belt Restraint Reduction in Nursing Homes: Effects of a Multicomponent Intervention Program. J Am Geriatr Soc [serial online]. 2011;59:2029-2036. Accessed November 19, 2012.