Geeta Sharma MSN, RN
Clinical Nurse Specialist - Nursing Quality & Safety
- Prevent the need for restraints when possible
- Attempt to use less restrictive alternatives
- Obtain an order from the physician prior to applying the restraint
- When placing a restraint, start with the least restrictive device
- Continually reassess the need for the restraint
- Remove the restraint as soon as possible
- Completely and accurately document the restraint episode
What is the difference between Non-Violent/Non- Self Destructive and Violet/Self Destructive?
Most often, restraints will be used for nonviolent and/or non self-destructive purposes. Remember violent and or self-destructive restraint behaviors are unanticipated outbursts. Once the outburst is completed, the restraint should be removed. Do not keep this patient in restraints for the potential to have violent or self-destructive behaviors. Violent and/or self-destructive restraints are used to manage violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member or others.
Are locked restraints always violent/self-destructive restraints?
Not necessarily. The type of restraint is determined by the behaviors the patient is experiencing and not the actual restraint used. If restraints are required to prevent the patient from pulling tubes, and soft limb and the neoprene/Velcro restraints are not effective in preventing the patient from pulling the tubes, as a last resort, locked restraints may be used.
Where can I use an enclosure bed?
Due to concerns of safety of enclosure beds, these are only available for use at AFCH, and University Hospital (D4/4 Hospital Medicine and D6/5, Acute medical Progressive Care Unit). These beds can be used at UH only with approval from the Director, Nursing Quality and Safety or designee or Nursing Director on call.
I am using only one limb restraint, is this considered a restraint?
Yes, this should be treated and documented as a restraint. This requires a physician order in addition to monitoring per the restraints at a glance document.
How do I get locked restraints?
By calling the Behavioral Response Team or inpatient psychiatry (263-7525).
When did restraints and side rails become bad? I think they keep my patients safe.
Restraints, including four side rails, have been identified as causing serious injury to patients. In 1997 the FDA released a safety alert on the hazards of restraints. Strict regulatory standards for monitoring patients in restraints were created. Restraints continue to cause injury. From 2009-2001, there were 29 sentinel events reported to The Joint Commission regarding restraints. All 29 patients had an outcome of death or permanent loss of function. The reporting is not mandatory, so it is likely there were more events that were unreported.
Why can’t I document that the patient is receiving tube feeding or IV hydration anymore?
It does not matter if the patient is receiving tube feedings or intravenous fluids. If the patient is allowed to have food/fluids by mouth, then they must be offered every hour while the patient is in restraints. The only exception is if the patient is NPO.
My Patient has requested all four side rails, because it makes them feel safe. Is this allowed?
No, due to the danger of serious injury from entrapment or from patients exiting the bed by going over the top of raised side rails, the use of all four side rails is prohibited except in the following situations four side rail use is considered necessary to keep a patient safe and is NOT considered restraint:
- During transport
- When using a stretcher
- When the bed needs to be elevated to facilitate care of the patient
- When a bed is used in the rotational mode
- When a bariatric specialty bed is being used
- When a low air lossmattress is required
- While recovering from sedation
- When neurologically impaired patients experience frequent spasms that could propel them out of bed
- When seizure precautions are required
- Raised rails in cribs or radiant warmer
- When the Hovermatt® is inflated
- Use of four side rails in situations other than described above requires the approval of nursing leadership, or designee