Download Restraint Policies

Restraint Policies

There are two categories of restraints. In both cases,
alternatives to restraint are to be tried or considered
before restraints are applied.

Goals/outcome of treatment: using the least
restrictive method necessary to maintain patient/staff
safety.
Behavioral Restraint Management
When a patient is a serious danger to himself or others:
 Physician must evaluate patient before or within 1 hr of
restraint application.
 One hour “face to face” evaluations for behavioral restraints
will be done by a “Qualified Psychiatric RN”.
 Behavioral Restraint Orders must be renewed every 4 orders
for patients 18 and older, every 2 hours for patients 9-17
years and every hour for patients 8 and younger. Orders can
be renewed verbally except once every 24 hours a
MD/ARNP/PAC must write an in-person order.
 Monitoring required every 15 mins. for patients in
behavioral restraints. (This is required for patients in
restraint, seclusion or both restraint and seclusion. The need
for a sitter is determined by the RN based on level of
observation needed).
 Assessment and documentation frequency every 24 hrs as
per the “Order Form”.
Restraint Policies

There are two categories of restraints. In both cases,
alternatives to restraint are to be tried or considered
before restraints are applied.

Goals/outcome of treatment: using the least
restrictive method necessary to maintain patient/staff
safety.
Behavioral Restraint Management
When a patient is a serious danger to himself or others:
 Physician must evaluate patient before or within 1 hr of
restraint application.
 One hour “face to face” evaluations for behavioral restraints
will be done by a “Qualified Psychiatric RN”.
 Behavioral Restraint Orders must be renewed every 4 orders
for patients 18 and older, every 2 hours for patients 9-17
years and every hour for patients 8 and younger. Orders can
be renewed verbally except once every 24 hours a
MD/ARNP/PAC must write an in-person order.
 Monitoring required every 15 mins. for patients in
behavioral restraints. (This is required for patients in
restraint, seclusion or both restraint and seclusion. The need
for a sitter is determined by the RN based on level of
observation needed).
 Assessment and documentation frequency every 24 hrs as
per the “Order Form”.
Release Criteria for Behavioral Restraint:
 Patient no longer a danger to self.
 Patient no longer a danger to others.
Trial Release
Intermittent releases will be used to evaluate if less restrictive
measures are appropriate and/or restraints can be discontinued.
Earthquake Emergency Procedures
 Drop - Take shelter under a table or desk. Seek cover
against an interior wall.
 Cover - Protect your head and neck with your arms.
 Hold - Stay under cover until the shaking stops and it is safe
to move.
Medical Restraint Plan
When a patient is cognitively impaired and has been attempting
to remove lines/support equipment, or is a demonstrated fall
risk.
 Medical Restraints do NOT require daily orders. Initial
order only.
 Order restraints prior to application; if emergently placed,
the restraint order must be obtained within 12 hrs.
 Assessment and documentation frequency every 24 hrs as
per the “Order Form”.
Fraud vs. Abuse
 Fraud is intentional violations.
 Abuse is a pattern of violations resulting from deliberate
ignorance or reckless disregard for the rules.
Criteria for Release:
 Pt. no longer drowsy or sedated.
 Tubes/devices no longer in place.
 Alert, oriented, following commands.
 Able to ambulate safely independently.
Release Criteria for Behavioral Restraint:
 Patient no longer a danger to self.
 Patient no longer a danger to others.
Trial Release
Intermittent releases will be used to evaluate if less restrictive
measures are appropriate and/or restraints can be discontinued.
Medical Restraint Plan
When a patient is cognitively impaired and has been attempting
to remove lines/support equipment, or is a demonstrated fall
risk.
 Medical Restraints do NOT require daily orders. Initial
order only.
 Order restraints prior to application; if emergently placed,
the restraint order must be obtained within 12 hrs.
 Assessment and documentation frequency every 24 hrs as
per the “Order Form”.
Criteria for Release:
 Pt. no longer drowsy or sedated.
 Tubes/devices no longer in place.
 Alert, oriented, following commands.
 Able to ambulate safely independently.
Patient Confidentiality
 HMC follows HIPPA regulations.
 Patient charts/any patient information must be disposed of
properly in confidential paper bins only, NOT waste/recycle.
Chemical Spills
 Rescue patients, staff and visitors (if safe).
 Call Public Safety at 4-5555 and state “Code Orange”.
Workplace Violence
 Stay calm
 Alert Public Safety at 4-5555
 Go to a safe area
 Wait for Public Safety
Earthquake Emergency Procedures
 Drop - Take shelter under a table or desk. Seek cover
against an interior wall.
 Cover - Protect your head and neck with your arms.
 Hold - Stay under cover until the shaking stops and it is safe
to move.
Fraud vs. Abuse
 Fraud is intentional violations.
 Abuse is a pattern of violations resulting from deliberate
ignorance or reckless disregard for the rules.
Patient Confidentiality
 HMC follows HIPPA regulations.
 Patient charts/any patient information must be disposed of
properly in confidential paper bins only, NOT waste/recycle.
Chemical Spills
 Rescue patients, staff and visitors (if safe).
 Call Public Safety at 4-5555 and state “Code Orange”.
Workplace Violence
 Stay calm
 Alert Public Safety at 4-5555
 Go to a safe area
 Wait for Public Safety
EMERGENCY PROCEDURES
Fire
Exercise R-A-C-E Procedures
 RESCUE
 ALARM
 CONTAIN
 EVACUATE
Evacuation Plan Methods
 Lateral – Inpatient Patient Care
 Vertical in West Clinics, Harborview Hall, and most off
campus buildings.
Emergency Codes
 Bomb Threat (4-5555) Code BRAVO
 Cardiac/Respiratory Arrest (222) Code BLUE
 Cyber Disaster (3-7012) Code CYBER
 Evacuation (4-5555) Code ECHO
 Fire (4-5555) Code RED
 Hazardous Material Spill (4-5555) Code ORANGE
 Heightened State of Alert (check Email
and/or 4-4636) Code ZEBRA
 High Census Management PURPLE LEVEL 1 or 2
 Infant/Child Abduction (4-5555) Code AMBER
 External Disaster Code ‘External Triage + #of Injured ‘
 Internal Disaster Code ‘Internal Triage + Location’
 Lockdown/Police Activity (check Email) Code SILVER
 Medical Assistance (222) MEDICAL ASSISTANCE
 Out of control behavior (4-5555) Code GRAY
EMERGENCY PROCEDURES
Fire
Exercise R-A-C-E Procedures
 RESCUE
 ALARM
 CONTAIN
 EVACUATE
Evacuation Plan Methods
 Lateral – Inpatient Patient Care
 Vertical in West Clinics, Harborview Hall, and most off
campus buildings.
Emergency Codes
 Bomb Threat (4-5555) Code BRAVO
 Cardiac/Respiratory Arrest (222) Code BLUE
 Cyber Disaster (3-7012) Code CYBER
 Evacuation (4-5555) Code ECHO
 Fire (4-5555) Code RED
 Hazardous Material Spill (4-5555) Code ORANGE
 Heightened State of Alert (check Email

and/or 4-4636) Code ZEBRA
 High Census Management PURPLE LEVEL 1 or 2
 Infant/Child Abduction (4-5555) Code AMBER
 External Disaster Code ‘External Triage + #of Injured ‘
 Internal Disaster Code ‘Internal Triage + Location’
 Lockdown/Police Activity (check Email) Code SILVER
 Medical Assistance (222) MEDICAL ASSISTANCE
 Out of control behavior (4-5555) Code GRAY
Reporting Exposures
 Report to your attending or nurse manager.
 Seek evaluation and prophylaxis through Employee Health
Service (x3081) or Emergency Trauma Center.
Compliance
 Compliance is HMC’s efforts to maximize our compliance
with laws and regulations that apply to us in order to
minimize risk of violations and penalties.
 Compliance is important because of a greater focus by the
Federal government with new laws, enforcement and
investigations.
TB Exposure
 Early identification and isolation to prevent spread.
 PAPR’s are available at x3305. Training is required.
Bloodborne Pathogens
Prevention Strategies:
 Vaccination for Hepatitis B.
 Proper disposal of used needles and syringes in a sharps
container, NOT in a waste can.
Infection Control
 OSHA/WISHA Infection Control Training available on-line.
 The HMC Infection Control Manual is online:
https://hmc.uwmedicine.org/BU/InfectionControl/Pages/InfectionControlManual.
aspx
HMC Pocket Reference Card
Key Information for
Medical Staff and Housestaff
HMC Mission Statement
Harborview Medical Center is a comprehensive health care
facility dedicated to the control of illness and the promotion and
restoration of health. Its primary mission is to provide and
teach exemplary patient care and to provide health care for
those patients King County is obligated to serve.
Quick Help: Turn to
 Emergency Reference Guide
 Charge Nurse/Nurse Manager
 Medical Staff and Housestaff Orientation Manual
https://hmc.uwmedicine.org/PolicyProcedure/Pages/PolicyH
ome.aspx
Key Phone Numbers
Medical Director’s Office: 744-3134
Public Safety/Security: 744-5555-emergency/ 744-3193-routine
Compliance: 543-3098/ 616-5248
Risk Management: 744-9570
Revised 02/2012
Reporting Exposures
 Report to your attending or nurse manager.
 Seek evaluation and prophylaxis through Employee Health
Service (x3081) or Emergency Trauma Center.
Compliance
 Compliance is HMC’s efforts to maximize our compliance
with laws and regulations that apply to us in order to
minimize risk of violations and penalties.
 Compliance is important because of a greater focus by the
Federal government with new laws, enforcement and
investigations.
TB Exposure
 Early identification and isolation to prevent spread.
 PAPR’s are available at x3305. Training is required.
Bloodborne Pathogens
Prevention Strategies:
 Vaccination for Hepatitis B.
 Proper disposal of used needles and syringes in a sharps
container, NOT in a waste can.
Infection Control
 OSHA/WISHA Infection Control Training available on-line.
 The HMC Infection Control Manual is online:
https://hmc.uwmedicine.org/BU/InfectionControl/Pages/InfectionControlManual.
aspx
HMC Pocket Reference Card
Key Information for
Medical Staff and Housestaff
HMC Mission Statement
Harborview Medical Center is a comprehensive health care
facility dedicated to the control of illness and the promotion and
restoration of health. Its primary mission is to provide and
teach exemplary patient care and to provide health care for
those patients King County is obligated to serve.
Quick Help: Turn to
 Emergency Reference Guide
 Charge Nurse/Nurse Manager
 Medical Staff and Housestaff Orientation Manual
https://hmc.uwmedicine.org/PolicyProcedure/Pages/PolicyH
ome.aspx
Key Phone Numbers
Medical Director’s Office: 744-3134
Public Safety/Security: 744-5555-emergency/ 744-3193-routine
Compliance: 543-3098/ 616-5248
Risk Management: 744-9570
Revised 02/2012