Restraints

1. Restraints Farhiyohassan Zabiti Omer

2. Restraints Purpose Interdiction Legal Implications of using Restraints Staff Education Stander Use of Restraints Nursing managments/Observation Complications Chemical Restraints Precautions http://www.youtube.com/watch?v=uq7VjSEBC2U

3. Purpose • To limit the use of restraints for non-behavior purpose. • To provide guidelines for the use of restraints in patient care and define documentation requirements.

4. What is restraints? • Restraints are any physical or pharmacological means to restrict a patient’s movement, activity, or access to their body. Patients have a right to be free from restraints unless restraint is necessary to treat their medical symptoms or to prevent patient from harming themselves or others.

5. Legal Implications of using Restraints • Federal and local laws have been passed that protect the patient from physical, mental abuse and from physical and chemical restraints except those that are authorized by physician in writing, for specified and limited period of time or that needed in an emergencies situation. • The devices must be applied by licensed, qualified personnel include physician’s assistants or nursing practitioners. Incase of emergencies situations clinical nurse manager may initiate before obtaining the written order. • Never use restraints for discipline or staff convenience.

6. Cont… • Writing Orders for restraints should include the time limitation, start and end time, type of restraint, in frequency of monitoring and reevaluation. • Time limitations should not exceed 24 hours. • If the patient is restrained because of behavioral, the should not exceed 4 hours for adults, 2 hours for children aged 19-17 years, and 1 hour for children younger than 9 years.

7. Staff Education • Teaching for care providers will be included in orientation and repeated as a necessary if problems are indentified through management. Teaching will be based on activities and responsibilities related to restraints use, which include: • Use of restraint alternative • Hospital policy • Less restrictive measures • Type of restraint and safe abdication

8. Con… • Body alignment and positioning • Patient comfort, modesty, right and respect • Patient and Family education • Patient monitoring/observation and reassessment: AV, signs of injury associated with application, skin integrity, circulation, and range of motion.

9. Stander Use Of Restraints • Temporary procedure or medical immunization is normally used during medical diagnostic or surgical procedures such as test, surgery, a circumcision or therapeutic holding. • Individual patients needs are assessed for postural support to balance for specific physical deficit and to promote maximum normative bodily functioning for example orthopedic braces and geriatric chairs. • Security or sitters to monitor patients being evaluated for suicidal ideation • Limb restrains used to restrain violent patient.

11. Nursing Management/ observation • Assess for skin condition before applying device. • Assess patient every 15-30 minutes: check placement of device, patient positioning, and neurovascular status. • Documentation such as • events/ behavior leading up to the intervention • Prior use of alternative measures • Patient response to the measures • Date and time the restraint was initiated

12. Chemical restraints • Chemical restraints are any medication used for the purpose of restraining patients involuntary to prevent them from harming themselves or staff. The purpose of using medications is long duration of action compare to the brief conscious sedation commonly used to facilitate procedures such as suturing, scanning, and joint reduction.

13. Advantages of Chemical restraints • Control violent behavior and patient agitation • May reduce need for physical restraints • Allow examination and performance of radiographic imaging

14. Disadvantages • May result in complications, such as respiratory depression and loss of gag reflex • Rare paradoxical reaction result in increased agitation • Limit mental status assessment and neurologic examination during sedation.

15. Agents • Agents that commonly used to achieve rapid tranquilization fall in categories of major tranquilizers/ neuroleptic agents. And benzodiazepines. • Tranquilizer/neuroleptinc • Haloperdiol (haldol): decrease agitation and violence behavior and often prescribed for acute psychotic person. Benzodiazepines: Diazepam, Lorazepam, Midazolam, Xanax. • Diazepam (valium) is used for sedation, treatment of agitation secondary to alcohol withdrawal and treatment of seizer.

16. Complication • Patient may have injuries that result from being restrained. Most injuries are minor and include abrasions and bruises. However, more serious injuries can occur if restraints are inappropriately applied. • Complications from pharmacological sedation are more frequent than from physical restraints.

17. Precautions • Patient dosing is very variable. More medication may be administer if inadequate sedations results after initial dose. • Monitor for respiratory depression and loss of gag reflex. • Immediate inadequate sedation my not mean that the medication is inappropriate for the patient. • Chemical restraint can be effective adjunct or replacement for physical restrains.

18. Reference • http://www.medceu.com/index/courses/restraints.htm • http://www.ncbi.nlm.nih.gov/pubmed/9180659 • Susan C. dewit. (2005). Fundamental Concepts and Nursing, ed.2