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The Use of Restraints and Physical Therapy

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

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The Use of Restraints and Physical Therapy

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  1. The Use of Restraints and Physical Therapy By Dymond Unutoa

  2. 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

  3. 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

  4. 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)

  5. Use Justification NON-Violent or NON-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

  6. Types of Restraint • Sitter • Wrist/Ankle Soft • Wrist/Ankle Leather • Posey Vest • Mitt • All 4 side rails engaged • Belts

  7. Types Continued • Chemical- Tranquilizers – Decrease agitation in acutely psychotic patients- Benzodiazepines (Valium) - Lorazepam – Elderly, long duration - Midazolam – Rapid sedation, short duration

  8. 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

  9. 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

  10. 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

  11. Complications • Injury – Abrasions and Bruises *Inappropriate application can lead to serious injury • Pressure sores • Circulation disruption • Loss of gag reflex - Sedation • DEATH

  12. PT Involvement • Collaborate with on-care nurse. • Patient education • Assessment of potential physiological outcomes • Orientation – Psychological/Cognitive patients • Intervention planning and POC • Family education

  13. Non-Restraint Devices • Orthopedically prescribed devises • Surgical dressings • Bandages • Any device that can be manually removed by patient in same manner as applied.

  14. Thought… • Does knowledge without action become neglect? – Safe Patient Handling

  15. 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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