WHO
These people can write a restraint order
MUST be an MD or NP order - ONLY
Federal and State regulations permit healthcare facilities to use restraints ONLY when MEDICALLY need (not behavioral)
Three things the RN would regularly evaluate on a patient when using restraints.
restraint secure; circulation (pallor, cyanosis and coolness of extremities); skin integrity; patient's response to the intervention and continued need for the restraint.
Restraints can be ordered for PRN use.
True or False?
False
Where have YOU seen restraints used?
(student response)
You must be able to slide ___fingers under the wrist/ankle restraint to provide a snug fit, but not so tight as to impair circulation.
2 fingers
Name TWO persons who are authorized to apply and remove restraints.
RN, LPN, CNA
RN must determine IF restraints are needed and choose the least restrictive type of restraint, evaluate effectiveness and continue to assess for complications
THREE alternatives to using restraints
Check the 3 P's; Potty, Pain, Position;
Diversional activities; decrease stimuli; bed/chair alarms; involve family and staff
The maximum amount of time a restraint order can be in place
24 hours - then a new order must be obtained.
THREE common clinical settings where restraints are used.
SNF, residential treatment facilities, emergency department, ICU, psychiatric hospitals, general hospital units
TWO actions that should be performed every TWO hours to help prevent impaired circulation and compromised skin integrity for a patient with restraints.
Skin care, passive and active ROM, ambulation, toileting, hydration and nutrition.
These non-medical persons must be notified when a restraint is placed.
Notify family of patient status change and need for restraint. Consent may not be necessary if there is an immediate threat to pt safety; however, as a rule, the family must be notified of the the use of restraints if the pt has a cognitive impairment. Many times family members prefer to sit with the pt as an alternative to the use of a restraint.
TWO possible negative PHYSICAL impacts to the patient when using restraints.
Impaired skin integrity; incontinence; aspiration; reduced heart and lung capacity; restricted circulation; DEATH
You check a patient with restraints every ___ minutes. You check and release restraints every ___ hours.
30 minutes- check
2 hours- check and release
The part of a hospital bed you would NEVER secure a restraint to.
Side rail of a hospital bed - quick release knot is used to prevent patient injury and for ease of caring for the patient.
Tie the knot on an IMMOVABLE part of the bed to prevent injury.
You would use hand mitts, instead of wrist restraints in this instance.
This person has the responsibility to document the need for, use of, and completion of regular checks when using restraints.
RN
TWO possible negative psychological/emotional impacts to the patient when using restraints.
increased agitation; anxiety; humiliation; fear; depression.
This is the only time you would resort to applying a physical restraint.
When dangerous behaviors continue despite all other less invasive alternative being tried and have failed.
The immediate physical safety of the pt, a staff member or others in threatened.
You would look here to determine that all less intrusive attempts have been attempted, and why they failed, prior to applying restraints.
RN charting
Agency policy, professional guidelines; Federal and State laws guide the use of ___________.
Restraints
Know YOUR agency policy!