Clinical skills Medical Restraints

Which of the following best describes what APS will do upon receiving your report of suspected elder or dependent adult abuse a) investigate within a max 10 days b)interview alleged victim c)interview collateral parties such as family members caregivers and or neighbors d)all of the above e) none of the above

D

Why are restraints used?

-"do no harm" -patient safety is primary concern

What are the 4 key points to medical restraint use?

-Medical restraints are used only as a last resort ( try descalation first, try verbal cues first) - always consider alternatives -Ensure physicians orders for use of restraints -Collaborate with medical team for compliance -Understand the role of PT in minimizing need for restraint use

An elder adult being neglected at home by their caregiver should be reported to ? a) CA attonery general b) the long term care ombudsman program c) CA state licensing d) adult protective services

D

Which of the following requires a mandated reporter to file a report? a) reporter has knowledge of suspected abuse or neglect of an elder or dependent adult b) reporter has observed suspected abuse or neglect of an elder or dependent adult c) reporter is told about suspected abuse or neglect of an elder or dependent adult d) All of the above

D

Abandonment, abduction, financial abuse are examples of what type of abuse?

non physical abuse

Adult Protective Services can't _______? a)place a client into a nursing home against their will b) contact law enforcement to obtain access to a suspected victim c) interview a client without their caregiver present d) make an abuse or neglect report without the clients consent

place a client into a nursing home against their will

De-escalation Techniques

10 key features for verbal de-escalation as provided by the American Association for Emergency Psychiatry De-escalation Workgroup include: • Maintain a distance of two arm's lengths • Maintain a relaxed and non-confrontational posture • Establish verbal contact • Use simple and concise language • Identify requests and feelings • Actively listen to what the patient is saying • Do not be afraid to agree to disagree • Set clear boundaries • Attempt to offer choices • Debrief the staff and patient

In case of abuse that results in serious bodily injury that takes place in a long term care facility the written SOC341 is due within _____ hours after reporting to law enforcement?

2 hours

What are Appropriate and Inappropriate use of restraints?

Appropriate -Avoid harm to self or others due to violence or self-injury • Avoid disruption of medical intervention such as breathing tubes or surgery sites • Prevent wandering or elopement (with psychiatrist assessment) • Prevent falls from bed, chair, or with walking** Inappropriate - Punishment of patient • Coercion of patient • Convenience of caregivers

What are Least Restrictive

Chair alarm Verbal cues, non-verbal cues "Sitter" or staff monitor Allow to walk/pace with supervision Top two rails up (does not require order) - allows them to move but not get out 4 rails up Padded rails Soft wrist restraint Vest Lap belts (like an airplane seatbelt with padding - tied in back)

Mandated reporters should NOT make voluntary reports if they learn of suspected abuse or neglect of an elder or dependent adult outside of their work responsibilities?

False

What are 7 ways to decrease falls?

PT may be ordered to assess/address Less agitation when able to move Assess medication side-effects Clear paths Use non-skid footwear Use night lights Avoid lines and tubes when possible

PT Implications for restraints

PT needs to talk with nurse before taking them off, nurse must check when you return to make sure they are re-applied correctly Need to discuss with the nurse if you are leaving the patient in a different position (started in supine but returned to sitting) Cannot leave patient alone without restraints- ask another staff to be present Guarding behind or postero-lateral Don't let the door close behind you, position yourself closer to the door PT performs skin checks even if the restraint is not removed entirely Equipment should have space for 2 finger widths to prevent compression and sores

What are 3 different restraints and explain?

Physical restraints limit a patient's movement. Chemical restraints are any form of psychoactive medication used not to treat illness, but to intentionally inhibit a particular behavior or movement. Environmental restraints control a patient's mobility

Associated Risks and Potential Problems with restraints?

Potential Risks include: Injury due to constriction, pressure, or strangulation Bowel and bladder management inconvenience or incontinence Pneumonia from immobility or aspiration Muscle atrophy Bone demineralization Impaired hydration or nutritional intake Anxiety and depression, PTSD Head of the bed must be elevated with physical restraints

What are the federal laws for use of medical restraints?

Restraint or seclusion may only be used when less restrictive interventions have been determined to be ineffective to protect the patient or staff member or others from harm Must have an order from a physician or independent practitioner per state law Patient must be seen face-to-face within 1 hour after initiation Specific documentation Staff training required Each order has a maximum time limit of 24 hours 4 hours for adults >18 years old 2 hours for 9 - 17-years old 1 hours for patients under 9-years-old

What is the California Law for use of medical restraints

Restraint shall be used only when alternative methods are not sufficient to protect the patient or others from injury. Patients shall be placed in restraint only on the written order of a licensed health care practitioner acting within the scope of his or her professional licensure. Patients in restraint by seclusion or mechanical means shall be observed at intervals not greater than 15 minutes. Restraints shall be easily removable in the event of fire or other emergency

Restraint Use for Fall Prevention

Restraint use is positively associated with falls (will increase likely hood of falls) Restraint use is associated with increased severity of injury in hospital patients who fall Restraint use is associated with decline in cognition, ADL performance, and walking Restraints lead to deconditioning, which increases risk of falls

A long term care ombudsman representative needs permission from an alleged victim of abuse or neglect to make a report T/F

True

The longterm care ombudsman program can not make a abuse or neglect repost unless the victim consents? T/F

True

The failure of individuals to support the individual, emotional, and social needs of adults dependent on others for their primary care is defined as _______?

care giver neglect

The 2 populations that mandated reports must file reports on if they suspect neglect or abuse are elders and _______?

dependent adults

Persons who have assumed responsibility for the care or custody of an elder or dependent adult are only mandated reporters if they are paid?

false