The Safe Use of Patient Restraints Mandatory Annual

The Safe Use of Patient Restraints Mandatory Annual Review Course

Safe Use of Patient Restraint Definitions Restraint is: Click each button for details § Any method of physically restricting a person’s freedom of movement, physical activity or normal access to his or her body. § Patient immobilization that is a normal component of a procedure is not considered restraint. Medical (Non-behavioral) Restraint: § A manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head freely to protect the patient. Behavioral Health Restraint: § The restriction of patient movement in response to severely aggressive, destructive, violent or suicidal behaviors that place the patient or others in imminent danger. Restraint is not: © Kaiser Permanente | For Internal use only | 2 § Forensic restriction used by law enforcement for security purposes.

Safe Use of Patient Restraint Side Rails – Restraint or Not? Click the answer The use of side rails may pose risk to patient’s safety. Clinical judgment determines whether or not the use of side rails is considered restraints. n Raising all four side rails to prevent the patient from exiting the bed n Four or full side rails to prevent the patient from rolling our of bed § Patient actively seizing § Post-op patient recovering from anesthesia § Patient on a gurney n Raising fewer than four side rails (when bed has more than two) © Kaiser Permanente | For Internal use only | 3 Restraint Not Restraint

Safe Use of Patient Restraint Alternatives to Restraints must never be used as a substitute for good nursing care or staff convenience. Restrained patients require MORE CARE and INCREASED DOCUMENTATION. PHYSICAL MEASURES SPIRITUAL NEEDS Relaxation techniques Promote normal sleep patterns Use of lap belt in chair as a reminder Provide glasses, hearing aid, dentures Tape foley to abdomen of male patient Use Activity Apron Exercise and activities Anticipate and provide for basic needs Contact patient’s pastor, minister, priest, rabbi Offer sacrament of Communion, Reconciliation, Anointing of the Sick Use sitter or volunteer to read to patient Use audio tapes, CDs ENVIRONMENTAL NEEDS 1: 1 communication Use of cushions to maintain safety Locate patient next to Nurse’s station PSYCHOLOGICAL MEASURES Use appropriate lighting Provide for companionship: family, friends Use Geri chair, position commode, walker, near bedside Orient to reality Decrease noise, control activity level Explain all procedures Place Call light within reach Use TV, radio, music Position tubes/drains out PHYSIOLOGICAL MEASURES of site Collaborate w/other healthcare members Provide pain medication, eliminate itch © Kaiser Permanente | For Internal use only | 4 Initiate frequent bathroom rounds Review medications for side effects & interactions

Safe Use of Patient Restraint Patient Assessment To Determine the NEED for RESTRAINT USE: n Attempt Alternatives n Use safe, effective and least restrictive method of restraint n Clinical Justification based on observed patient actions or behaviors n Interference with therapy or patient care § § Activity or thoughts with a reasonable probability of harm to self § § Pulling tubes Picking at wounds Removing dressings Wandering Unsteady gait (high risk for falls) Suicidal Activity or thoughts with a reasonable probability of harm to others § § § Confused patient striking out at others Homicidal attempt or talks about killing/harming someone Violent patient in alcohol or drug withdrawal © Kaiser Permanente | For Internal use only | 5

Safe Use of Patient Restraint Orders Restraints will be initiated or continued on the order of a treating physician. The order must meet the following criteria: ü Reason for the restraint. ü Be time specific ü Include type of restraint. ü Reflect least restrictive manner. ü Be in accordance with safe and appropriate restraining techniques. ü Be discontinued at the earliest point in time. ü Never be written as a standing order or PRN. © Kaiser Permanente | For Internal use only | 6

Safe Use of Patient Restraint Medical vs. Behavior Health Orders Medical Time Limitations Behavioral Health 24 hours 18 yrs or older 2 hours 9 -17 yrs 1 hour 8 yrs and under RN Assessment Every 2 hours or sooner Continuously document every 15 mins MD Assessment Every 24 hours prior to writing new order Every 8 hours 18 yrs or older Every 4 hours 17 yrs and younger Emergency Application by RN Notify MD ASAP, within 1 hour MD must provide telephone or written order. MD must assess patient ASAP, within 24 hours. Notify MD ASAP, within 1 hour MD must assess patient and write order. Restraint Reapplication Requires new order, and MD assessment. -Even if original order has not exceeded its “time limit. ” This does not include the temporary release that occurs for patient assessment. © Kaiser Permanente | For Internal use only | 7

Safe Use of Patient Restraint Observation & Monitoring Assessment will include: n The patient’s physical and emotional well-being. n Comfort and care needs, including hygiene, elimination, hydration, nutrition n The appropriateness of restraint application, removal, and reapplication n Assessment of the need for continuing or discontinuing restraint Patient death associated with restraint use: § § § RN will immediately notify Nurse Manager or House Supervisor Complete a UOR (unusual occurrence report) Hospitals AR&L Director or designee will notify CMS © Kaiser Permanente | For Internal use only | 8

Safe Use of Patient Restraint Application of Restraint n Must have quick-release application n Use the correct size n Note “front” and “back” of device n Secure to bed springs or frame, not mattress or bed rails n Do not apply one-sided restraints n Do not restrain feet while their hands are free n Place call light and necessary items within reach n Do not position pregnant patients 20 weeks or greater on their back, nor should chest or waist restraints be used Restraints should be discontinued as soon as it is no longer indicated by the patient’s actions. © Kaiser Permanente | For Internal use only | 9

Safe Use of Patient Restraint Documentation Patient basic needs must be attended to, including: n Hygiene n Elimination n Hydration n Nutrition n Circulation n Range of motion Document the following in Patient’s record in KP Health Connect: § § § § Physician’s order Initial assessment by the RN and 1 hour in-person evaluation by MD Patient’s actions or condition that indicated the initial and continued use of restraint Less restrictive alternatives considered Patient monitoring and response to interventions used Significant changes in the patient’s condition Reassessment/observations, discontinuation of restraints Education and information about restraints provided to the patient and family © Kaiser Permanente | For Internal use only | 10