Chapter 11: Restraint Alternatives and Safe Restraint Use

Mitt restraints are not typically secured to the bed or chair. Therefore, the person can raise the mitt up to his or her mouth. Observe the person closely to make sure that he or she does not...

- bite the mitt to remove or damage the material - ingest any mitt material

What observations should you report to the nurse at once when you check on a person or remove/release the restraint?

- discomfort - numbness, pain, or tingling in the restrained part - cold, pale, or cyanotic fingers/toes (for wrist, mitt, or ankle restraints) - difficulty breathing (for belt, jacket, or vest restraints) - a tight restraint

Drugs are chemical restraints if they...

- control behavior - restrict movement - are not used to treat a person's medical condition

Straps to prevent sliding should always be over the _______, not around the ________ or _______.

thighs waist chest

_______ and _______ restraints are applied to the chest. They have the same purpose as belt restraints.

vest jacket

Each time you check on the person (every 15 minutes) check for circulation. For mitt, wrist, and ankle restraints, you should feel a pulse at a pulse site below the restraint. Fingers or toes should be _______ and _______.

warm pink

Cloth restraints (soft restraints) are mitts, belts, straps, jackets, and vests. They are applied to the wrists, waist, ankles, hands, and chest. Leather restraints are only applied to the _______ and _______. Leather restraints are used for extreme agitation and combativeness.

wrists ankles

Sometimes drugs can help persons who are confused or disoriented. They may be anxious, agitated, or aggressive. The doctor may order drugs to control these behaviors. The drugs should not...

- make the person drowsy - prevent the person from functioning at his or her highest level

While the restraint is removed or released, what should you do?

- measure vital signs - meet elimination needs - provide for food or fluid needs - meet hygiene needs - give skin care - perform range-of-motion exercises - provide for physical and emotional comfort

What are the legal aspects (laws) of restraint use?

- restraints must protect the person - a 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

Entrapment can occur between...

- the bars of a bed rail - the space between two half-length bed rails - the bed rail and mattress - the head-board or foot-board and mattress

List some alternatives to restraint use that can be implemented before actually applying a restraint.

- the person does jobs or tasks he or she consents to - family, friends, or volunteers visit - diversions are provided (TV, magazines, books, radio, relaxation tapes, etc.) - the person wanders in safe areas - all staff are aware of persons who wander (housekeeping, maintenance, the business office, dietary, etc.) - knob guards are used on doors - falls/injuries from falls are prevented (padded hip protectors are worn under clothing, roll guards are attached to bed frame) - confused persons are oriented to person, time, or place (calendars and clocks are provided) - pillows, wedge cushions, and posture and positioning devices are used - food, fluid, hygiene, and elimination needs are met - a calm, quiet setting is provided - outdoor time is planned for nice weather - observations and visits are made at least every 15 minutes or as depicted in the care plan - the person is moved to a room close to the nurse's station

Restraints may only be used when...

- treating a medical symptom - the immediate physical safety of the person or others is at risk - when other appropriate restraint alternatives have failed to protect the person or others

Injuries can occur as the person tries to free themselves of the restraint. Injuries also can occur from...

- using the wrong restraint - not applying the restraint correctly - leaving the restraint on too long

Restraints are medical devices. The Safe Medical Devices Act applies if a restraint causes illness, injury, or death. Also, the CMS requires the reporting of a death that occurs...

- while a person is in a restraint - within 24 hours after a restraint was removed - within 1 week after a restraint was removed - if the restraint may have contributed directly or indirectly to the person's death

Remove or release the restraint and re-position the person every ______ hours or as often as noted in the care plan. The restraint is removed or released for at least _______ minutes.

2 10

_______, like OBRA, protect the person's rights and safety. This includes the right to be free from restraint.

CMS

Besides the CMS, the _______, state agencies, and _______ (an accrediting agency) have guidelines for safe restraint use. They do not forbid restraint use, but require considering or trying all other appropriate alternatives first.

FDA TJC

True or False: A jacket restraint is applied with the opening in the front.

False.

True or False: A restrained person requires less staff time than properly supervising and observing the person.

False.

True or False: You can apply a restraint before being instructed about its proper use.

False.

True or False: Persons with mitt restraints are not allowed to walk around.

False. Persons with mitt restraints may be able to walk around. Falls are a risk - practice safety measures to prevent falls.

True or False: A vest restraint is applied with the "V" neck and the vest crosses in the front.

True.

True or False: Drugs cannot be used if they affect physical or mental function.

True.

True or False: If you apply an unneeded restraint, you could face false imprisonment charges.

True.

True or False: In an EMERGENCY, a nurse is able to decide whether or not a restraint is needed before getting a doctor's order.

True.

True or False: Injuries are more serious from falls in restrained persons than in those not restrained.

True.

True or False: Position the person in good alignment before applying the restraint.

True.

True or False: Restraints must be discontinued as soon as possible.

True.

enabler

a device that restricts freedom of movement but is used to promote independence, comfort, or safety; a.k.a a restraint alternative

medical symptom

an indication or characteristic of a physical or psychological condition

discipline

any action that punishes or penalizes a person

convenience

any action that: - controls or manages a person's behavior - is not necessarily in the person's best interest - requires less effort by the agency

freedom of movement

any change in place or position of the body or a part of the body that the person is able to control

chemical restraint

any drug used for discipline or convenience that is not used to treat a person's medical symptoms

physical restraint

any manual method or physical or mechanical device, material, or equipment that he or she cannot remove easily and that restricts freedom of movement or normal access to one's body

Wrist restraints (limb holders) limit _______ movement. When are wrist restraints used?

arm - if the person is at risk for pulling out tubes needed for life-saving treatment (intravenous infusion, feeding tube) - if the person scratches at, pulls at, or peels the skin, a wound, or a dressing - is at risk for pulling out devices used to monitor vital signs

Never use force to apply a restraint. If a person is confused or agitated, what can you do?

ask a co-worker to help you apply the restraint

You as a CNA must clearly understand the reason for the restraint and its risks. If you don't understand, what should you do?

ask the nurse

Physical restraints confine the person to a _______ or _______, or they restrict the movement of a body part.

bed chair

A _______ restraint is used when falls are a risk or for positioning during a medical treatment. The purpose is so that the person is not able to get out of bed or out of a chair. However, a _______ _______ allows the person to turn from side to side or sit up in bed.

belt roll belt

Secure restraints according to agency policy. The policy should follow the manufacturer's instructions and allow for quick release in an emergency. Quick-release _______ or airline-type _______ are used. So are quick-release _______.

buckles buckles ties

Make sure the _______ _______ is within the person's reach with the restraint on. Also make sure he or she can reach other needed items, such as water, tissues, phone, bed controls, and so on.

call light

Physical restraints are applied to the...

chest waist elbows wrists hands ankles

Restraints are made of _______ or _______.

cloth leather

Use bed rail _______ or _______ _______ as instructed by the nurse. They prevent entrapment between the bed rails or the bed rail bars.

covers gap protectors

Cuts, bruises, and fractures are common, but the most serious risk factor associated with restraints is...

death from strangulation

The CMS, FDA, TJC, and state laws are apart of every agency's policies and procedures when it comes to restraint use. Restraints must never be used for _______ or for staff _______.

discipline convenience

When the person can easily remove the device and it helps the person function, it is considered an _______.

enabler

Restraints were once used to prevent falls, but research now shows that they actually cause falls. How do restraints increase the risk for falls?

falls occur when a person tries to free themselves of the restraint

Mitt restraints prevent _______ use. They allow hand, wrist, and arm movements. They have the same purpose as wrist restraints.

finger

The belt is applied around the waist and secured to the bed or chair. A chair belt is called a _______ belt. It is applied over a garment.

lap

The person must be comfortable in the restraint and able to move the restrained part to a limited and safe extent. You could be _______ if you do not apply the restraint properly.

negligent

remove easily

the manual method, device, material, or equipment used for a person that he or she can intentionally remove in the same manner it was applied by the staff example: the person can put bed rails down, untie a knot, or unclasp a buckle

How do you check for snugness with a restraint that is applied to the chest or waist? How do you check for snugness with a restraint that is applied to the wrists or hands?

the restraint fits well if you can slide a single flat hand in between the person's body and the restraint the restraint fits well if you can slide one finger between the person's body and the restraint