Chapter 12 - Restraint Alternatives and Safe Restraint Use (textbook)

freedom of movement

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

Types of Restraints

Cloth restraints (soft restraints) Mitts, belts, straps, jackets, and vests. Applied to the wrists, ankles, hands, waist, and chest. Leather restraints : Applied to the wrists and ankles. Wrist restraints: Used when a person continually tries to pull out tubes used for life-saving treatment. (intravenous infusion [IV], feeding tube) Mitt restraints: Prevent finger use. Allow hand, wrist, and arm movements. Belt restraints: Prevent person from getting out of bed or out of a chair. A roll belt allows the person to turn from side to side or sit up in bed. The belt is applied around the waist and secured to the bed or chair (lap belt). It is applied over a garment.

Complications of restraint use

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. The most serious risk is death from strangulation. There are also mental effects.

Safety guidelines

Observe for increased confusion and agitation. Protect the person's quality of life. Follow the manufacturer's instructions. 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. Remove the restraint, reposition the person, and meet basic needs at least every 2 hours. Follow the care plan.

Time frame when observing the resident who is restraint

Residents who is restrained needs to be checked every 15 minutes

Applying restraints

Restraints are made of cloth or leather. Restraints may increase confusion and agitation in persons with dementia. Never use force to apply a restraint. Ask a co-worker to help apply the restraint if needed. Report problems to the nurse at once. Wrist restraints (limb holders) limit arm movement. Hands are placed in mitt restraints. Belt restraints are used when injuries from falls are risks or for positioning during a medical treatment.

Safe Restraint Use

Restraints can cause serious injury and even death. Centers must follow: OBRA guidelines CMS guidelines FDA guidelines TJC guidelines State laws Restraints are not used to discipline a person or for staff convenience.

Legal aspects of restraints

Restraints must protect the person. A written 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.

Medical Devices and restraints

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.

Restraint Application

The least restrictive method is used. Allows the greatest amount of movement or body access possible. Some restraints attach to the person's body and to a fixed (non-movable) object. Restricts freedom of movement or body access. Vest, jacket, ankle, wrist, hand, and some belt restraints are examples. Other restraints are near but not directly attached to the person's body (bed rails or wedge cushions). Partially restrict freedom of movement. They allow access to certain body parts and are the least restrictive.

Report and record:

The type of restraint applied The body part or parts restrained The reason for the application Safety measures taken The time you applied the restraint The time you removed the restraint The person's vital signs The care given when the restraint was removed Skin color and condition Condition of the limbs The pulse felt in the restrained part 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)

Other types of restraints

Vest restraints and jacket restraints are applied to the chest. A jacket restraint is applied with the opening in the back. For a vest restraint, the vest crosses in front. 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. Death can occur from strangulation. Never use force to apply a restraint. If a person is confused or agitated, ask a co-worker to help apply the restraint. Report problems to the nurse at once.

risks of restraint use

agitation anger constipation contractures cuts and bruises decline in physical function dehydration delirium depression loss of dignity embarrassment and humiliation falls fractures head trauma incontinence infections mistrust nerve injuries pressure ulcers loss of self respect reduced social contact strangulation withdrawal

medical symptom

an indication or characteristic of a physical or psychological condition

physical restraint

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

chemical restraint

any medication that is used for discipline or convenience and not required to treat medical symptoms

remove easily

the manual method, device, material, or equipment used to restrain the person that can be removed intentionally by the person in the same manner, it was applied by the staff