Management of Restraint

1. Management of Restraint Next Steps: • Establish cause of behaviors • Treat underlying cause • Attempt less restrictive alternatives • Use of restraint if alternatives do not work

2. Management of Restraint: Obtain Physician Order • Determine reason for application: med/surg or behavioral • No PRN orders; must be time limited • Order needs to be dated and timed • Order must be time limited. Maximum time for med/surg application is 24 hours. Maximum time for behavioral is 4 hours for adults, 2 hours for children age 9-17, and 1 hour for children under age 9 • Must have reason for utilization of restraint documents • Type of restraint • Action that will permit release • Signature of LIP or individual that took the order

3. Six Components of Order for Restraint • Date and time order written • Duration of order • Reason for utilization of restraint • Type of restraint • Action that will permit release • Signature of individual who took order

4. Management of restraint It is the policy of MountainView Regional Medical Center to strive for a restraint-free environment. Patient has a right to be restraint free and that attention is paid to the patient’s well-being and comfort.

5. Management of restraint Definitions: • Physical restraint: any apparatus that interferes with the free movement of the patient

6. Management of restraint Establish clinical justification: • Medical/surgical reason for application of restraint: unintentional, unanticipated danger to self • Behavioral Restraint: Aggressive and/or destructive behavior that places the patient or others in potential or imminent danger

7. Management of restraint Physician not available to give order: Med Surg application: • Competent RN, LIP, or other physician may apply • Obtain physician order in 12 hours • Physicians must sign and date order in 24 hours

8. Management of restraint Behavioral application: • Competent RN, LIP, or other physician may apply • Physician or other licensed independent practitioner must see and evaluate the need for restraint within one hour • Physician must sign and date the order with 24 hours

9. Management of restraint Observe and monitor: • Use appropriate flow sheet Med/surg: Document ever 2 hours. VS etc can be done with CNA. RN needs to reassess the patient for the need of restraint at a minimum of ever 2 hours.

10. Management of restraint Behavioral: • Document every 15 minutes • CNAs may assist with monitoring • RNS must reassess at least every 2 hours for continued need for restraint

11. Management of restraint Patient/family education: • Educate regarding the need, alternatives and behaviors which will facilitate the removal • Document in the Meditech “Interdisciplinary notes” if family member objects to restraint. Explain potential risk resulting from lack of restraint to patient and document in record. • Family member/SO may be requested to stay with the patient

12. Management of restraint Continued education: • Correct and safe application of restraint • Other clinical disciplines involvement and education Performance Improvement: • Process and outcome measurement will be monitored at least quarterly and reported to the Board of Trustees