Seclusion and Restraints

Staff will determine the form of Seclusion and Restraint

* "Staff shall afford to individuals who do require restraints, the least number of restraint points and the maximum freedom of movement that will ensure the physical safety of the individual and others * The basis staff uses to decide which restraints are appropriate for a patient is the least restrictive mode

Dictionary Definition of Imminent

* About to occur, impending * Likely to occur at any moment * Ready to take place * Coming or likely to happen very soon * Note - It hasn't happened yet... but it's going to happen!

PPE Personal Protection Equipment (Know where it is)

* Access Situational Need * Availability of PPE * Gloves * Spit Net * Containment Blanket * Face Shield * Gown, Booties * Application of PPE

T* Use a process to determine Imminent Risk

* Identify the precursor behavior early, example: if a Pt clenches his fist prior to his assaults, the clenching of fists is a precursor or antecedent for assault * Engage using de-escalating techniques in an attempt to avoid seclusion or restraint * Continually assess the Pt. using a mental status assessment to determine if the Pt is responding favorably or continues to escalate T* If he continues to escalate despite your efforts, teh patient is Imminent!

Seclusion and Restraint Standard for Use

* Is avoided whenever possible and used only to ensure the safety of all persons after all verbal and less restrictive interventions have been attempted and were either unsuccessful or deemed unsafe * Is appropriate only when the patient or others need to be protected from injury and the use of less restrictive measures poses a greater risk than the risk of using seclusion and restraint * Must never act as a barrier to the provision of safe and appropriate care, treatments and other interventions to meet the needs of patients * Must be terminated as soon as the patient is no longer an imminent danger to self or others

How the narrative should Flow: Negative Interventions Assessment Rational for Behavior | | Seclusion or | | | Restraint | | | | V V V V |--------------|----------------|-------------|

* Negative Behavior * Interventions * Assessment * Rational for Seclusion or Restraint

Seclusion & Restrains Very Important

* No individual shall be permitted to sleep in restraints without justification and regular assessment per policy.

Doctors Orders/Assessment

* Nursing staff Do Not have to wait until there is a doctor's order before placing a Pt in full bed restraints * A doctor's order will be obtained no later than 15 minutes after the application of seclusion or restraint * The order must state the type of restraint or seclusion to be used, the time limits of the order (no longer than 4 hours), and language that specifies criteria for release. * Doctor is to see the individual face to face within 1 hour after Seclusion and Restraint application * Subsiquent orders will be every 4 hours until released * Doctor must do a face to face no less than every 8 hours until released

Imminent Dangerousness

* Nursing staff do not have to wait until the patient acts out violently to apply restraints

High Acuity Patients (Any one on a one-to-one is a level (5))

* Pts in restraints or seclusion are considered high acuity patients. * They require a staff member to be with them at all times * They require a Psychiatrist to write an order every 4 hours until they are released from restraints

Use of Prone Position

* Rational (reason) * Respirations (monitored) * Time (monitor and record time in Prone position)

Title 22 (71545) Restraint of Patients

* Restraints shall be used only when alternative methods are not sufficient to protect the patient or others from injury

Two Hour Re-Assessment on Restraints (every 2 hours... unless)

* Restraints should be remove every two hours for the Pt's skin to be assessed unless it is unsafe to do so * "The individual shall be re-assessed by nursing staff no less than once every 2 hours to evaluate that individual's condition and the need for continuing restraints or seclusion."

Restraint Definition

* Retraint and Seclusion in plain terms, are techniques used to control or modify challenging behavior by force or isolation. * "Restraint" means controlling a patient's physical activity in order to protect t5he patient or others form injury

Interventions to Avoid Restraints

* Safety First! * If a Pt is angry and is escalating towards potentially violent behavior it is best to assemble a number of staff together and develop a plan of action

Special Incident Reports (SRIs)

* Separate SIR for each individual involved * Include the DPS case # in the narrative * FAX Blue SIR's front and back to NOD * Make copy of SIR (Front and Back) and attach to SIR filled out data forms and place int he Unit Supervisor's box * File the original blue SIR in IDN

Assessments

* Staff shall not presume the need fro seclusion or restraint based solely on the individual's previous need for these emergency interventions or based solely on a history of dangerous behavior * Evidence of current imminent harm at an emergency level with a failure of all other possible options must be presented each and every time the use of seclusion or restraint is utilized to ensure safety

Documentation

* The medical record must include clear documentation of the clinical need for restraint (or seclusion) use. (This must include specific Pt behaviors and the present danger to Pt, staff or others.) * If restraints were used as an emergency intervention, document the nature of the emergency situation. * Follow the agency policy regarding obtaining the physician's order and the required face-to-face assessment * Document all the alterations to restraint that failed prior to initiation of physical restraint. * Document the pre-restraint assessment conducted by the Licensed Nurse. Include not only the findings but any actions taken to correct problems (e.g. attemts to deescalate aggressive behavior, calom the anxious Pt, etc.

Q: What is the standard when we can apply Seclusion or Restraint?

T* A: If the Pt is an imminent danger! * Restraint or seclusion can be used for behavioral emergencies only when a person's behavior presents an imminent danger of serious harm to the person or others

Alternatives to Seclusion and Restraints

T* Make a "contract"* (negotiating and contracting) T* Do not threaten the Pt with violence or any type of retribution