Restraints Flashcards
What is the definition of a restraint?
Anything that restricts or controls a person’s movement or behaviour
What are the three types of restraints?
- Physical - Geri/Broda chair, chair with locking table top, full bed side rails, back fastening seatbelt, bed alarm, wander guard
- Chemical - sedatives, tranquilizers
- Environmental - secure units, seclusion room, half door
What is the law regarding use of restraints?
If necessary to prevent serious bodily harm
If it drives greater freedom or enjoyment of life
Authorized by plan to which patient has consented
Order can only be written by physician or person specified by regulation
Must monitor and reassess
Risk factors for use of restraints
Cognitive impairment
Poor mobility
Dependence for ADLs
Behaviours
Family request
Wellbeing of caregiver
Lack of policy
Lack of knowledge regarding person centred care
What are the most common reasons for use of restraints?
- Fall prevention
- Confusion/delirium
- Patient/family request
- Agitation
- Prevent wandering
- Prevent aggressive behaviour
What are risks of restraint use?
Physical: pressure injury, incontinence, constipation, inc risk falls, inc dependence ADLs, dec muscle strength, infection, fractures, severe injury like strangulation, infection
Psych: depression, isolation, discomfort, fear, anger, humiliation, delirium, PTSD
Patient: longer LOS, inc hospital mortality, lower odds of being discharged home, dec ADLs, dec walking/gait
What is a problem solving approach to the use of restraints?
- Identify the problem
- Analyze the problem
- List possible strategies
- Choose a strategy
- Take action
- Assess results
What are the risks of indwelling catheters?
- Infection - UTI, epididymitis
- Restricted mobility
- Discomfort
- UI
- Skin erosion
- Urethral strictures
- Gross hematuria
- Bladder cancer
- Bladder fistula
- Bladder perforation
What are the Choosing Wisely guidelines regarding use of catheters?
- Don’t place or leave in place without reassessment
- Don’t place or leave in place without acceptable indication
What are appropriate indications for use of catheter?
- Acute retention or bladder outlet obstruction
- Need for accurate output
- Perioperative for: urologic, long surgery, large volume infusion, intraop monitoring
- Healing of open sacral or perianal wound in incontinent patients
- Required prolonged immobilization
- Comfort for EOL
Inappropriate use of indwelling catheters
- Substitute for nursing care of patient or resident with incontinence
- Obtain UCX when patient can void
- Prolonged post op duration
How to prevent complications with a catheter?
- Continuously closed drainage system
- Do not routinely irrigate
- Daily catheter review
Changing at routine fixed intervals not recommended
Patient has cloudy urine with indwelling foley. What are 3 management recommendations?
- Re evaluate for indication
- Encourage hydration
- Consider alternatives - intermittent, condom catheter
How to appropriately use chemical or physical restraints?
- Ensure appropriate indications - imminent harm to others or patient, significant disruption of important treatment, continuation of effective behaviour tx, use after all other means exhausted
- Lowest dose for shortest duration
- Regularly reassess with restraint free periods
- Used with consent
- Must comply with policy and legislation
Develop a policy for use of restraints at your hospital
- Define restraints
- Develop decision tree surrounding use
- Alternatives to restraints
- Use according to specifications of device
- Document forms for behaviour, alternatives used, date and time, reason, type of restraint, patient response
- Ongoing reassessment
- Educate staff on policy
- Ensure it complies with legislation
- Document consent
