Restraints A
A restraint that can be soft wrist, soft ankle, net bed, or a chemical medication that is above the normal dosage for an adult. It is used to protect the patient or staff from harm.
What is a Violent/Self Destructive Restraint.
Re-orientation
De-escalation
Limit Setting
Increased observation and monitoring
Change in the physical environment
Review of modification to medication regimens
What is alternative or interventions to using a restraint?
Patient is trying to pull out IV. She is confused and does not understand when told to not pull out her IV. A soft wrist restraint is applied.
What is a Non-violent/Medical Care restraint? Patient is only confused. All other alternatives have been attempted but she continues to pull on her IV.
Patient is found on the floor but no witness to what has happened.
What is a unwitnessed fall.
Training to patient, and family
Training to onboarding staff
Continued training and reminders to staff
Rounding on patient to make sure precautions are in place
Agitated, Aggressive/combative, self abusive behavior
What is the rationale for Violent/Self Destructive Patient restraint use
Date/Time of order
Type of restraint to be used
Reason for the restraint
Release/removal criteria
What is required in a physician's order for restraint?
Patient has a Non-violent/medical care restraint in place that must be monitored, and assessed.
Non-Violent/medical care restraint has to be monitored hourly, and renewed every 24 hours.
Standard Fall Risk
High Fall Risk
Extreme High Fall Risk
All patient in the hospital are standard fall risks
High Fall risks require alarms, and possible camera rooms.
Extreme High Risk required a camera room and documented checks every 30 minutes.
Fractures, internal bleeding, and possibly death.
What is injuries from a possible fall in the hospital?
Patient is now oriented to environment, is now in control and refraining from destructive acts, aggression, and is no longer a threat to self or others.
What is the release criteria for Violent/self destructive restraints?
Staff cannot discontinue a restraint intervention then restart it under the same order. This trial release constitutes a PRN use of restraints.
What is no restraint order can be PRN. If restraints are removed and the patient has to go back into restraints, a new order is required.
An RN initiates a restraint in an emergency, as they are trying to protect staff. Immediate step after making the patient safe is...
What is obtain a physician's order as soon as the situation allows.
Toileting needs, Alcohol or drug intoxication, Dementia patients that can move quickly out of bed.
What are the high risk, or extreme high risk for falls in the hospital?
The most common factor around falls that could be managed with a scheduled program.
What is toileting program. Having a program in place to toilet patients or ask patients every 2-3 hours can significantly reduce falls. Most falls in the hospital occur around toileting.
This face to face assessment has to be completed within one hour and documented in the chart by the physician. This must be completed on this type of restraint.
An assessment this is done every 15 minutes to make sure the patient is safe.
What is the Behavioral Restraint Monitoring Flow sheet that is required to be documented on every 15 minutes. This is required for Violent/self destructive restraints.
Violent/Self Destructive Behavioral Restraints have a special colored monitoring flow sheet and order form.
What is purple? This was done so the correct monitoring flow sheet will be completed for violent/self-destructive restraint.
Alarm is sounding in a room, all clinical staff are busy with other patients. Who is responsible for responding to alarm.
Everyone that hears the alarm is responsible! Even if you are walking by, you may be able to prevent a fall with an injury! Just stay with the patient until clinical staff arrives!
Top reasons patients fall in the hospital
4 hours for adults over 18 and above
2 hours for children 9-17
1 hour for patients under the age of 9.
What is the time limit for Violent/self destructive restraint initial order?
Plan of care with behaviors, nursing interventions, and date, time of implementation.
What is a care plan. Care plan must be documented on all types of restraints. This includes in the ED!
All patient have the right to be restraint free. SMC is committed to providing a safe environment for patients and staff.
Restraints are to be used to ensure immediate physical safety of a patient after alternatives have been attempted.
Assessments
Education to staff
Anticipating potential high fall risk patients
Interventions in place before something happens
Ways to enhance fall precautions and prevention of falls.
Adverse outcomes because of falls