Physical Restraints

Don't restraint patient in prone position

-Limits the patient's field of vision -Intensifies feeling of helplessness & vulnerability -Impairs respiration, risk of asphyxia

Nursing care for a patient who is on physical restraint

-Monitor patient hourly -Ensure patient safety -Restraint are properly secured and not too tight -Check respiratory status -Check peripheral circulation for warmth, sensation, distal pulses and colour -Inspect skin condition for pressure related injuries -Ensure range of movement are not restricted -Check body alignment and movement -Conduct 2 hourly turning to prevent pressure-related injury -Evaluate patient's behaviour for discontinuation of physical restraint -Attend to basic needs such as comfort, eating, drinking, toileting as required -Release restraints for 5-10 min at least 2 hourly **with companion throughout the period of release

Criteria of using physical restraints

-Must obtain a written physician order within 1 hour -When all alternative measure are not effective -To prevent physical injuries to self or others and damage to property

Re-evaluation of continued need

-Order on the use of restraints are usually limited to 24 hours -patient needs to be reassessed by doctor -continued order need to be written and signed by the doctor for further restraints

Physician order has to specify

-Reason for use of restraint -Type of restraint to be used -Duration of restraint on patient -Criteria for discontinuation

Documentation treatment and progress notes

-Reason of restraint -Explanation and communication to patient&NOK -Type of restraints used -Date and time applied -Condition of skin and joint movement

Inform caregiver

-Reasons for using physical restraints -Anticipated duration for the use of restraint -Criteria for discontinuation

Special considerations

-Restrain patient on his side when patient is at high risk for aspiration -Never secure restraints to side rails -Don't restraint a patient in the prone position -Skin breakdown can occur -Can predispose a patient to pneumonia, urine retention, constipation and sensory deprivation -Caution to patient that has history of seizure

Inform the companion to

-Stay beside the patient all the time -Call for help if unable to manage the patient -Inform nurse should he/she leave the patient's bedside

Types of physical restraints

-bed rails -fully body/waist vest -hand mittens -seat belts or chest boards/ trays -limb restraints

Applying limb restraints

-check that 1-2 finger space is allowed between restraint and patient's wrist/ankle -fasten the free ends of restraint to bed frame out of patient's reach -use quick-release knot for easier release -ensure patient's arm is not hyper-flexed -provide reassurance -ensure comfort and safety

Assessment

-determine patient's condition and need to apply restraint -inform doctor when patient need to apply restraint and obtain a written order for the use of restraint within 1 hour unless situation warrants immediate actions -inspect patient's skin condition

Prevent skin breakdown

-pad patient's wrists and ankle -loosen/remove restraint frequently -provide regular skin care

Planning

-position patient correctly, away from harm -Apply restraints when patient is lying down in bed or sitting in a high back chair -Get assistance if necessary -explain procedure and purpose to get compliance -involve next of kin where available -select appropriate size of restraints with good condition -remove obstacle if necessary

Never secure restraints to side rails

-someone might inadvertently lower the rail -may jerk the patient's limb or body, causing discomfort/trauma

Applying body restraint

-wrap body restraint around lumbar region -ensure restraint does not allow patient to turn over -Ensure some movements are permitted by placing an open palm between patients abdomen/ chest and the restraint -Ensure no compression is placed onto wounds, invasive lines or tubes

Caution for patient who has history of seizure

High risk of fracture and trauma

Limb restraints

Patient who are extremely violent, aggressive and agitated to prevent patients from harming themselves or others Limit use as it: -Cause physically and physiological harm to patient

Full body/waist vest

Patients who are disorientated, suicidal, restless or at risk of fall limit use as it: -restrict chest or abdominal movements -slide upwards to throat and obstruct airway if improperly applied

Hand mittens

Patients who are violent, to prevent distruption of therapeutic intervention attempt to pull out wound dressing, IV tubes, invasive lines

Long periods of immobility can predispose a patient to pneumonia, urine retention, constipation and sensory deprivation

Reposition the patient and attend to his elimination requirements as needed

Seat belts or chest boards/trays

Secured across the front of a chair/ wheelchair to keep patient in proper position and prevent them from falling

Bed rails

To prevent patient rolling out of bed accidentally

Physical restraints

any physical method of restricting a person's: freedom of movement physical activity normal access to his/her body