Safety and Security: Use of Protective Restraints and Prevention of Falls

1. Safety and Security: Use of Protective Restraints and Prevention of Falls

2. Introduction • Promoting safety and preventing injury for the patient is fundamental for nursing practice. • No matter what type of patient you care for, safety is a high priority. One of the most common risks is that of a fall. • It is important that nurses be aware of the potential for injury and promote safety at all time.

3. Prevention of Falls • “Falls in an individual can be prevented if they can be predicted.” • Who is the individual who is a high risk for a fall?

4. Risk Assessment Tool • There are many risk assessment tools available. The Hendrich Fall Risk Assessment is one example:

5. Question Tell whether the following statement is true or false. A nurse whose behavior is reasonable and prudent and similar to the behavior that would be expected of another nurse in similar circumstances is still likely to be found liable if a patient falls. A. True B. False

6. Interventions to Prevent Falls in a Health Care Facility? • Orient to new surroundings • Keep two side rails up (depending on policy) • Keep call light, bedside table, water, glasses, etc. within easy reach • Use a night light • Keep bed in low position • Make sure patient has non-skid footwear • Teach fall prevention techniques • Ambulate only with assistance when appropriate • Locate patient close to the nurses station

7. Patient Teaching • It is important to teach the patient and family measures to prevent falls in the home. • Review measures in Box 26-1, p. 622

8. Restraints / Protective Devices • Definition: • A physical or mechanical device used to limit or prevent a patient’s movement. • FDA – device that limits movement to the extent necessary for treatment, examination, or protection of the patient

9. Purposes for Use of Restraints Most commonly used to: • Prevent the patient from falling and sustaining injury • Disoriented patients • Prolonged bedrest • Patients who are hypotensive, have lost a lot of blood, receiving narcotics, etc. • Position and protect patient during treatments and to maintain ongoing care • Prevent pulling on catheter, nasogastric tube, stitches • Protect patients who are combative and agitated and may cause harm to self or others

10. The use of restraints is generally not advocated and should be used only as a last resort

11. Types of Restraining Devices • Mechanical/Physical • Wrist, ankle, elbow, mitten restraints • Belts **Use of vest restraints is no longer advocated • Chemical • Medications used to calm an individual’s behavior – tranquilizers and hypnotics 3. Environmental • Side rails – all 4 up on bed. • Locked units • Locking devices on wheelchairs • Grab bars

12. Safety Measures Guidelines in Applying Restraints • Apply ONLY for the safety of the patient, NEVER for convenience of the nurse • Apply with care to avoid damaging tissue and causing harm to the patient • Recognize the physiological and psychological effects of applying restraints • Explain reason to the patient and family • Review the policy and procedure manual • Choose the restraint that fits the need

13. Documentation of Restraints • Patient’s behavior that supported the need for the restraint and what was used before applying restraints • Type of restraint used • Explanation of purpose of using the restraint to the patient and or family • If patient or family refuses the restraint • Exact time that the restraint was applied • Continued assessment of the patient every 2 hours and care given while in the restraint • Notification of the physician

14. Ask Yourself? • What do the nurse do if the patient needs a restraint and there is NO health care provider order?

15. Ethical / Legal Implications • Emotional issue on the part of the patient, family, and staff. The patients response to being restrained is rarely submissive • Many view restraints as a personal physical assault, and are frightened, and respond by becoming combative. • The application of restraints may subject the nurse to allegations of false imprisonment, battery, and lack of informed consent.

16. Legal implication with Misuse of Protective Restraints • The Joint Commission has identified misuse of protective restraints as one of the main sentinel events (unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof). • Since the Joint Commission began tracking sentinel events in 1996, the Accreditation Committee of the Joint Commission's Board of Commissioners has reviewed many cases related to deaths of patients who were being physically restrained. Most of the events occurred in psychiatric hospitals, followed by general hospitals and long term care facilities.

17. Complications • Suffocation from entrapment • Impaired circulation • Altered skin integrity — pressure ulcers • Diminished muscle and bone mass / Fractures • Altered nutrition and hydration • Aspiration and breathing difficulties • Incontinence • Changes in mental status

18. How do we decrease these complications??? • Try alternative measures • If absolutely necessary to use – • Follow the Safety Measures and Guidelines

19. Alternatives to the Use of Protective Restraints • Use a bed alarm system • Senses when patient gets out of bed • Senses when patient steps on it when getting out of bed • Provide a familiar environment • May need to bring items from home • Increase the monitoring frequency • May ask family to help with the monitoring, but it is difficult for family to commit to this amount of time

20. Alternative – Use Sitters • Patients or residents with an impaired ability to understand or follow directions, or appreciate the potential for self-harm as a consequence of his/her actions, may have a sitter prescribed by a physician to provide continuous one-to-one observation. Sitters are responsible for observing the patient and maintaining a safe environment. • When sitters are used, they are under the direction and delegation of a registered nurse who monitors the patient’s or resident’s actions. Sitters may be non-licensed patient care staff, or other hospital employees who have completed sitter competencies.

21. Question Which one of the following is an accurate guideline regarding the use of restraints on patients? A. Restraints should be used routinely to prevent falls in the elderly population. B. The patient’s family must be consulted and involved in the plan of care prior to using restraints. C. Even in the case of an emergency, a physician’s order must be obtained prior to using a restraint. D. All restrained patients must be monitored and assessed on an hourly basis.

22. Ask Yourself! • If a patient complains of a restraining device causing them pain or discomfort, what should the nurse do?