Patient Care and Safety Notes

Immobilization and Sedation

• The use of sedation and immobilization requires a delicate balance between ethical treatment and clinical benefits.
• Restraints should be limited to clinically appropriate situations that absolutely require them.
• Temporary immobilization with devices or sedation may be needed for a pediatric patient's safety and successful procedures.
• Sedation alternatives include:
  • Enlisting a parent to comfort the child.
  • Distraction.
  • Topical local anesthesia.
• Chemical sedation should only be used when other efforts have failed or clearly will not work.
• Holding and comforting young patients is not considered restraint if the family or legal guardian agrees it's harmless and appropriate.
• Sedation might be required for children younger than six years or those with developmental disabilities who can't cooperate.
• Immediate restraint or sedation might be necessary if a child or adolescent becomes agitated or dangerous.
• Children can have serious adverse reactions to chemical sedation, including hypoventilation, airway obstruction, apnea, and cardiopulmonary impairment.
• All pediatric sedation should be administered after a thorough medical history and under medical supervision.
• Staff must have immediate access to an emergency cart with age and size appropriate rescue drugs and equipment.
• The use of immobilization devices, restraint, and chemical sedation requires a physician's written order.
• Children or adolescents placed in restraints or administered sedation should be continuously monitored.
• Staff must record all use of restraint and sedation in the patient's medical record.

Patient and Family Centered Care for Infants, Children, and Adolescents

• Clinical environment for infants (birth to about two years) should focus on safety and general comfort.
• Newborns and young infants are often more comfortable when swaddled.
• Parents can hold a swaddled infant during some procedures with appropriate positioning, sterile draping, or shielding for radiation protection.
• Decrease stress by providing young children with understandable information and giving them some sense of control.
  • Example: allowing a child to touch an instrument or listen through a stethoscope.
• Preparing the room completely before a toddler arrives can avoid unnecessary delays and agitation.

Care for Uncooperative Patients

• Age-appropriate communication strategies should be used, but sedation may be required if these fail.

Fall Prevention Techniques for High Fall Risk Patients

• ID bracelets identify the most at risk patients to the medical team.
• Hospital bedrails are a preventive measure, but can be dangerous if a patient tries to climb over them.
• Leaving patients' beds at their lowest level is helpful.
• Providers must always bring a bed to its lowest position if they plan to leave a patient unattended.
• Restraints are a last resort to confine a high risk patient to the bed.
• Always get consent prior to using restraints and discuss the decision with a supervisor and family members or caregivers.

Additional Considerations

• Emergency medical services personnel should be prepared for agitated or violent patients and involve law enforcement or implement safety or restraint measures according to organizational policy.
• Healthcare workers should follow institutional policies, accreditation standards, and local regulations regarding use of restraints and documentation.
• Patient restraints are ethically and legally controversial.