VCU DPT - Lifespan 2 (Restraints and Seclusion)

you want restraints to be your

last resort

what is restraint

any method of restricting freedom of movement served to manage indiv behavior

what is seclusion

patient is involuntarily put into a room or area, and then prevented from leaving

- even if prevention is implied

_______ is a method or device that prevents/reduces ability to freely move

- indiviual cannot easily and intentionlly remove device the same way it was put on

physical restraint

a physical restraint is one that _________ ability, and the individual __________ remove device

prevents/reduces

cannot remove

the following are examples of ________:

wheelchair tray, belt, chair alarm, enclosed bed, bed rails (if intention is to limit getting up from bed), band mitts, soft splints

restraints

are the following physical restraints?

protective helmets?

holding patient for exam?

surgical dressings?

seperating people in order to break up a fight?

NO

what are things to ask yourself when seeing if soemthing is a physical restraint or not

what is the intent?

can patient voluntarily leave?

did patient consent?

what is a chemical restraint

med used to subdue behavior or restrict movement

NOT a standard treatment/dosage

if you give someone a typical treatment/dosage that subdues behaviors, is it a chemical restraint?

if intent is purely for reducing activity, then yes

chemical restraint is a medication for subduing activity that is _____ stndard treatment/dosage

NOT

your patient is independent when she came to facility. staff placed alarms on bed at night to alert if she got up, so the patient stopped getting up at night to go to bathroom. she told her daughter she was afraid the alarm would wake up her roommate, but patient has no need for alarm.

is this a restraint

YES

- intent is to keep her in the bed with no medical reason

- can not voluntarily turn it off

- patient did not consent

patient is new to facility. staff suggested other alternatives, but patient prefers to use partial bed rails and has given written consent. patient can easily get in and out of bed with the partial rails. staff have also watched him put down rails by himself

restraint?

NO

- chose rails

- gave consent

- voluntarily take them down

- only a restraint if patient does not consent, can not take them down

restraint use is most prevalent in _________ client populations

vulnerable

what are some vulnerable client populations you might see higher usage rates of restraints

higher chronological age

black race

hispanic

getting care for mental health

lack of insurance

unhoused individ

does patient fall risk change with restraint use?

NO

- no evidence that restraint use is effective in reducing fall or injury risk

physical restraints may contribute to _________ fall frequency/injury severity

increased

what are some physical risks for restraint use

bowel and bladder issue

skin breakdown

respiratory complications

strangulation

MSK issues from trying to get out

what are some psychosocial impact of restraint use

feeling of being punished

- loss of confidence, self respect, dignity

increased risk of delirium

anger and fear, panic, imprisoned

when is restraint or seclusion appropriate

when the patient pose immediate harm to themsleves or others, and must be stopped at earliest possible times

what are inappropriate times to use restraint/seclusion

staff convenience

coercion

retaliation, discpline

fall prevention

pateints and residents have the right to be free of _______ restraints

unnecessary

restraints __(can/can not)___ be used as part of a fall prevention plan

can not

name some less restrive alternatives to restraint use

enviro changes

physical considerations

psych considerations

de-esclaation strategies

early intervention

clear, calm and nonj udgemental approach

ID requests and feelings

do not argue one's experience

allow adequate processing and response time

offer flexibility when possible

redirect when possible

maintain safe distance

these are strategies for _____________

de escalation

process to restraint/seclusion use:

comprehensive patient _________ -->

evaluation of _______ restrive approach -->

______ order -->

staff inervention (3 steps)

assessment

less

physician

application, monitor, reporting

with physical reestraints, you never restrain in _____ position

prone

chemical restraint should be ______ acting with ____ side effects

fast

minimal

if you restraint or seclusion, how often do you have to check in on patient

every 15 min

do you need to document restraint and seclusion

YES