Unit 15 Restraints

Unit 15

Restraints Nurse Aide I Course

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Restraints Introduction Under OBRA, residents have a right to be free from restraints. As a member of the multidisciplinary team, the nurse aide plays an integral role in achieving a restraint free environment. DHSR Approved Curriculum-Unit 15

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Restraints Introduction (continued)

When alternatives to restraints are not effective, however, and the physician orders restraints, it becomes essential for the nurse aide to know the risks involved in caring for these residents. DHSR Approved Curriculum-Unit 15

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15.0 Identify and discuss the safety precautions to be considered when using restraints.

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Facts Regarding Restraints • Ordered by the physician when necessary to treat a medical symptom or provide emergency medical treatment • Choice of restraint based on multidisciplinary evaluation for the least restrictive measure

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Facts Regarding Restraints (continued)

• Types of acceptable restraints – hand or mitts – soft ties for wrists and ankles – vests and safety belts – lap cushions – lap trays

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Facts Regarding Restraints (continued)

• Types of unacceptable restraints – using bed rails to keep resident from voluntarily getting out of bed – tucking in top sheet so tightly that resident cannot move – using wheel chair safety bars to prevent resident from getting out of chair DHSR Approved Curriculum-Unit 15

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Facts Regarding Restraints (continued)

• Types of unacceptable restraints (continued) – placing resident in wheel chair so close to a wall that the wall prevents resident from getting out of chair

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Facts Regarding Restraints (continued)

• Reasons for use of acceptable restraints – Temporarily for life threatening medical conditions – Brief periods to allow medical treatment to proceed if there is documented evidence of resident or legal approval of treatment DHSR Approved Curriculum-Unit 15

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Facts Regarding Restraints (continued)

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15.1 List eight considerations that would be important when using restraints.

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Considerations When Using Restraints • Used to protect residents and not to aid staff • Restraints require physician’s order • Need for restraint should be apparent (unnecessary use is false imprisonment)

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Considerations When Using Restraints (continued)

• Staff must provide for the restrained resident’s basic needs, with special attention to elimination needs

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Considerations When Using Restraints (continued)

• Secure enough help to apply restraints quickly to prevent injury • Use reassurance in an attempt to calm agitated residents in restraints • Apply according to manufacturer’s directions DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents • Check on resident frequently • Apply restraint only after you have received instructions in its use • Protect bony areas and skin by padding them prior to applying restraint • Adjust restraint so that it allows some movement, but is secure DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Assure that resident can breathe easily in a vest restraint • Check pulse, color and temperature of any restrained extremity and breathing of resident in vest restraint every 15 minutes DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Use slip knot to tie restraint for quick release • Secure restraints to bed frame, not to side rails

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Safety Measures For Restrained Residents (continued)

• Loosen restraint, stay with resident, and use call signal to notify supervisor immediately: – when unable to detect a pulse in restrained extremity – when fingers/toes are cold, pale or blue in color DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Loosen restraint, stay with resident, and use call signal to notify supervisor immediately (continued): – if resident complains of pain, discomfort, numbness, or tingling in restrained part DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Loosen restraint, stay with resident, and use call signal to notify supervisor immediately (continued): – when skin appears red or damaged under restraint – when breathing is impaired with vest or safety belt restraint DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Carry scissors in pocket to cut restraints in emergency situations • Remove restraints for 10 minutes and reposition resident every two hours DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Be sure resident needs are met when restrained • Keep call signal within resident’s reach

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Safety Measures For Restrained Residents (continued)

• Recording restraints should include: – The type of restraint • mitt • wrist • vest • ankle • waist belt DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Recording restraints should include (continued): – Time restraint applied – Each time restraint loosened and resident repositioned – Time restraint removed – Condition of resident DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Observations and reporting should include: – Color and condition of skin under restraint – Pulse rate, color and temperature of skin in restrained extremity DHSR Approved Curriculum-Unit 15

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Safety Measures For Restrained Residents (continued)

• Observations and reporting should include (continued): – Any complaints about restrained part – Red or injured skin areas under restraint – Respiratory rate and color of skin with vest and safety belt restraints DHSR Approved Curriculum-Unit 15

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15.2 Demonstrate the application of restraints.

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15.3 Demonstrate the application of a safety belt restraint.

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15.4 Identify a sampling of alternatives to avoid the use restraints.

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Alternatives To The Use Of Restraints Using friends, family, volunteers or sitters Diverting with interesting activities Answering call signal promptly Exercise and outdoor activities DHSR Approved Curriculum-Unit 15

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Alternatives To The Use Of Restraints (continued)

• Electronic warning devices on beds and doors • Consistent reality orientation and staff assignments • Having room close to nurses’ station

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