Promoting a Restraint-Free Promoting a Restraint-Free

EnvironmentEnvironment

HEALTH SCIENCEHEALTH SCIENCE

CONSIDERATIONS FOR CONSIDERATIONS FOR CARECARE

OBRA:OBRA: Defines “physical restraints” as any method or Defines “physical restraints” as any method or

equipment used on or near the resident’s body that equipment used on or near the resident’s body that the resident cannot remove easily and which the resident cannot remove easily and which restricts freedom of movement or normal access to restricts freedom of movement or normal access to one’s bodyone’s body

States that residents have the “right” to be free from States that residents have the “right” to be free from restraints which are unnecessary, inappropriate or restraints which are unnecessary, inappropriate or not required to treat the resident’s medical not required to treat the resident’s medical symptomssymptoms

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CONSIDERATIONS FOR CONSIDERATIONS FOR CARECARE

Drugs or drug dosages are restraints if Drugs or drug dosages are restraints if they:they: Control behavior or restrict Control behavior or restrict

movementmovement Are not standard treatment for the Are not standard treatment for the

person’s conditionperson’s condition

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TERMSTERMS RestraintRestraint is any manual method or physical or is any manual method or physical or

mechanical device, material, or equipment attached to mechanical device, material, or equipment attached to or near the person’s body that he or she cannot remove or near the person’s body that he or she cannot remove easily and which restricts freedom of movement or easily and which restricts freedom of movement or normal access to one’s body.normal access to one’s body.

SeclusionSeclusion is involuntary confinement of a person alone is involuntary confinement of a person alone in a room or area from which the person is physically in a room or area from which the person is physically prevented from leaving.prevented from leaving.

Freedom of movement Freedom of movement is any change in place or is any change in place or position of the body or any part of the body that the position of the body or any part of the body that the person is physically able to control.person is physically able to control.

Remove easily Remove easily means that the device, material, or means that the device, material, or equipment used to restrain the person can be removed equipment used to restrain the person can be removed intentionally by the person in the same manner it was intentionally by the person in the same manner it was applied by the staffapplied by the staff..

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REQUIRMENTS FOR REQUIRMENTS FOR RESTRAINT USERESTRAINT USE

Require written doctor’s order that specifies Require written doctor’s order that specifies reason for restraintreason for restraint

May be used only to treat or protect resident-May be used only to treat or protect resident-not for discipline or staff conveniencenot for discipline or staff convenience

Least restrictive type of restraint must be used Least restrictive type of restraint must be used for least amount of timefor least amount of time

Must be used only as last resort when all other Must be used only as last resort when all other methods have failedmethods have failed

Informed consent requiredInformed consent requiredSlide 5

DANGERS OF DANGERS OF RESTRAINT USERESTRAINT USE

Physical effects such as skin damage, Physical effects such as skin damage, circulatory impairment, incontinence, circulatory impairment, incontinence, nerve/muscle injury, pneumonia, serious nerve/muscle injury, pneumonia, serious injury and deathinjury and death

Emotional effects such as depression, Emotional effects such as depression, frustration, anger, agitation, disorientation frustration, anger, agitation, disorientation and loss of self-esteemand loss of self-esteem

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ROLE OF CNA IN AVOIDING ROLE OF CNA IN AVOIDING NEED FOR RESTRAINTSNEED FOR RESTRAINTS

General Measures:General Measures: Keep environment calm, restfulKeep environment calm, restful Eliminate multiple stimuliEliminate multiple stimuli Speak in calm, gentle mannerSpeak in calm, gentle manner Provide kind, respectful careProvide kind, respectful care Treat residents as individualsTreat residents as individuals Meet residents’ needs, eg. Elimination, Meet residents’ needs, eg. Elimination,

positioning, activitypositioning, activity Adjust staff and environment to resident’s needs-Adjust staff and environment to resident’s needs-

not vice versanot vice versa

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ROLE OF CNA IN AVOIDING ROLE OF CNA IN AVOIDING NEED FOR RESTRAINTSNEED FOR RESTRAINTS

Observations and Problem-SolvingObservations and Problem-Solving Make careful observations of resident to Make careful observations of resident to

identify what:identify what: Causes problem behaviorCauses problem behavior Calms or distracts residentCalms or distracts resident

Report your objective Report your objective

observations to charge nurse observations to charge nurse

to assist nurse in to assist nurse in

care-planningcare-planningSlide 8

ROLE OF CNA IN AVOIDING ROLE OF CNA IN AVOIDING NEED FOR RESTRAINTSNEED FOR RESTRAINTS

provide care following instructions of charge nurse and provide care following instructions of charge nurse and care plan to:care plan to: Eliminate cause of behaviorEliminate cause of behavior Calm or distract residentCalm or distract resident

Continue to report Continue to report

observations to observations to

charge nurse to charge nurse to

assist nurse with assist nurse with

evaluating plan of evaluating plan of

carecare

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SAFETY GUIDELINESSAFETY GUIDELINES

Observe for increased confusion and agitation.Observe for increased confusion and agitation. Protect the person’s quality of life.Protect the person’s quality of life.

Restraints are used for as short a time as possible.Restraints are used for as short a time as possible. Follow the manufacturer’s instructions.Follow the manufacturer’s instructions. Apply restraints with enough help to protect the person Apply restraints with enough help to protect the person

and staff from injury.and staff from injury. Observe the person at least every 15 minutes or more Observe the person at least every 15 minutes or more

often as required by the care plan.often as required by the care plan. Remove or release the restraint, reposition the person, Remove or release the restraint, reposition the person,

and meet basic needs at least every 2 hours.and meet basic needs at least every 2 hours. Follow the care planFollow the care plan..

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REPORT AND RECORDREPORT AND RECORD The type of restraint appliedThe type of restraint applied The body part or parts restrainedThe body part or parts restrained The reason for the applicationThe reason for the application Safety measures takenSafety measures taken The time you applied the restraintThe time you applied the restraint The time you removed or released the The time you removed or released the

restraint and for how longrestraint and for how long The person’s vital signsThe person’s vital signs The care given when the restraint was The care given when the restraint was

removed or releasedremoved or releasedSlide 11

REPORT AND RECORDREPORT AND RECORD

Skin color and conditionSkin color and condition Condition of the limbsCondition of the limbs The pulse felt in the restrained partThe pulse felt in the restrained part Changes in the person’s behaviorChanges in the person’s behavior Complaints of discomfort, a tight restraint; Complaints of discomfort, a tight restraint;

difficulty breathing; and pain, numbness, difficulty breathing; and pain, numbness, or tingling in the restrained part (Report or tingling in the restrained part (Report these at once.)these at once.)

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APPLYING RESTRAINTSAPPLYING RESTRAINTS Restraints are made of cloth or leather.Restraints are made of cloth or leather.

Leather restraints are applied to the wrists and ankles.Leather restraints are applied to the wrists and ankles. Wrist restraints (limb holders) limit arm Wrist restraints (limb holders) limit arm

movement.movement. Hands are placed in mitt restraints.Hands are placed in mitt restraints.

They prevent finger use.They prevent finger use. The belt restraint is used:The belt restraint is used:

When there is risk of injury from fallsWhen there is risk of injury from falls For positioning during medical treatmentFor positioning during medical treatment

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VEST AND JACKET VEST AND JACKET RESTRAINTSRESTRAINTS

A jacket restraint is applied with the opening in the back.A jacket restraint is applied with the opening in the back. The straps of vest and jacket restraints always cross in the The straps of vest and jacket restraints always cross in the

front.front. Vest and jacket restraints are never worn backward.Vest and jacket restraints are never worn backward. The restraint is always applied over a garment.The restraint is always applied over a garment. Vest and jacket restraints have life-threatening risks.Vest and jacket restraints have life-threatening risks. You are advised to only assist the nurse in applying them.You are advised to only assist the nurse in applying them. The nurse should assume full responsibility for applying a The nurse should assume full responsibility for applying a

vest or jacket restraint.vest or jacket restraint. Never use force to apply a restraint.Never use force to apply a restraint.

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