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THE USE OF RESTRAINTS AND PHYSICAL THERAPY
By Dymond Unutoa
Objectives
Understand the definitions of Restraint Understand Restraint purposes Recognize Types of Restraints Know possible Alternatives before
Restraining Understand the process of Restrain
Application Recognize Complications with Restraint
use Understand how Physical Therapy can be
Involved Recognize Non-Restraints
Definition of Restraint
1) Any 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; or
2) A drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition
Purpose
Protection from self and others upon display of violent and unsafe behavior in environment/situation
Care management for a patient who exhibits behavior that is interfering with POC or intervention (i.e. pull on tube/IV)
Use Justification
NON-VIOLENT ORNON-SELF DESTRUCTIVE
VIOLENT/SELF DESTRUCTIVE
Pulling at Invasive Tubes or Lines
Patient safety – Attempts to leave bed when exhibiting disorientated/confused behavior with potential injury to self
Interruption of surgical/wound maintenance (picks at site)
Emergency Behavioral Situation – Physically aggressive with significant potential to harm self or others
Types of Restraint
Sitter Wrist/Ankle Soft Wrist/Ankle Leather Posey Vest Mitt All 4 side rails
engaged Belts
Types Continued
Chemical- Tranquilizers – Decrease agitation in acutely psychotic patients- Benzodiazepines (Valium)- Lorazepam – Elderly, long duration- Midazolam – Rapid sedation, short duration
Considerations
Alternatives Preserving patient rights and dignity Safe application Environment – Their access to
surroundings Patient’s ability to participate in POC Risks associated – Behavior, child,
cognitive
Alternatives to Restraint
Encouragement for family involvement
Patient location in relation to staff
Position of patient bed
Use of Call bell Bed/Exit Alarms Reorient patient to
environment Conceal IV/Tube sites
Application
Assessment for restraint use performed by RN
Physician or LIP that’s authorized to elicit restraint use can do so as per hospital policy
Checked every 15 min Orders in writing Orders must not exceed 24 hrs
Complications
Injury – Abrasions and Bruises*Inappropriate application can lead to serious injury
Pressure sores Circulation disruption Loss of gag reflex - Sedation DEATH
PT Involvement
Collaborate with on-care nurse. Patient education Assessment of potential physiological
outcomes Orientation – Psychological/Cognitive
patients Intervention planning and POC Family education
Non-Restraint Devices
Orthopedically prescribed devises Surgical dressings Bandages Any device that can be manually
removed by patient in same manner as applied.
Thought…
Does knowledge without action become neglect? – Safe Patient Handling
References IASIS Health Care Risk Management Manual. Origination (9/28/08).
Restraint and Seclusion (Section: Clinical Risk Policy Number: RMCO.011)
MedCEU Restraint Continuing Education Course. http://www.medceu.com/index/index.php?page=get_course&courseID=3631&nocheck. Accessed November 17, 2012
Haut A, Kolbe N, Strupeit S, Mayer H, Meyer G. Attitudes of Relative of Nursing Home Residents Toward Physical Restraints. Journal of Nursing Scholarship [serial online]. 2010;42:4,448-456
Williams D. Restraint Safety: an Analysis of Injuries Related to Restraint of People with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities [serial online]. 2009;22:135-139.
Wilson C, Klein A, Kirsch N (Michigan Chapter). Proposal RC 29-12 – The Role of PT in patient handling. Adopted June 2012 in House of Delegates to APTA.
Gulpers M, Bleijlevens M, Ambergen T et al. Belt Restraint Reduction in Nursing Homes: Effects of a Multicomponent Intervention Program. J Am Geriatr Soc [serial online]. 2011;59:2029-2036. Accessed November 19, 2012.
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