Download Using Restraints

Textbook for Nursing Assistants
Chapter 10: Patient Safety and Restraint Alternatives
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Accidents and Incidents
and the PCT Role to Prevention
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
What you will learn?
• Define accident and incident
• Identify risk factors that put people in health
care facilities and increased risk
• Understand the importance of reporting
accidents and incidents
• List and identify the various types of
restraints
• Identify safety concerns of restraints
• Describe methods to reduce the need for
restraints
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Accidents and Incidents
• An accident is an unintended, unexpected event that has
the potential for causing bodily harm
• An incident is an occurrence that is considered unusual,
undesired, or out of the ordinary that disrupts the usual
routine of the patient, the resident or the facility
• Accidents and incidents can involve patients, residents,
staff or visitors of a facility
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Accidents and Incidents
• Facilities are required by OBRA to maintain an
environment that lowers the risk of accidents and
incidents to the greatest possible extent
• Facilities achieve this by providing patients and residents
with adequate supervision and assistance to prevent the
occurrence of accidents and incidences
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factors That Cause Accidents
• Some factors that place people at risk for accidents are
–
Age
–
Medication effects
–
Impaired mobility
–
Sensory impairment
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Risk Factor: Age
• Infants are helpless
– accidental suffocation
– falls
• Young children lack knowledge about things that are dangerous
– falls
– burns
– poisoning and drowning
• The elderly are at high risk for accidents because of the
physical and mental effects of the aging process
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factor: Medication
• Many medications can affect the ability of a person to be
safe including
– Pain medications
– Medications that affect blood pressure
• Effects of medication can be
– Dizziness
– Sedative effect
– Confusion
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factor: Paralysis
• The person is unable to move or feel part of the body
• Puts the person at a risk of falls, burns, and other injuries
• Caused by a spinal cord injury or a stroke (“brain attack”)
• Paralysis from the waist down is known as paraplegia
• Paralysis from the neck down is known as quadriplegia
• Paralysis on one side of the body is known as hemiplegia
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Risk Factor: Poor Mobility
• Factors associated with poor mobility are
– Pain and stiffness from arthritis
– Conditions that cause a person to shuffle his feet
when he walks (e.g., stroke)
– Injuries or surgeries involving the leg
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Risk Factor: Sensory Impairment
• Visual impairment can lead to
– Falls, accidental poisonings
• Hearing impairment can lead to
– Road accidents, suffocation or fire accidents, accidental
poisonings
• Impaired sense of touch can lead to
– Accidental burns
• Impaired sense of smell can lead to
– Food poisoning, suffocation, or fire accidents due to
gas leak
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Risk Factor: Limited Awareness of
Surroundings
• Confusion and disorientation caused by
reactions to medication, head injuries,
dementia, and other medical conditions
can lead to accidents
• A person who is unconscious or comatose
is totally unable to respond to his or her
environment and needs assistance to
remain safe
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Reporting and the
PCT
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Reporting
• An accident should be reported
immediately and an incident (occurrence)
report should be completed promptly
• The report is to be completed in an
objective and nonjudgmental way, without
blaming anyone
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Using Restraints
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Restraints-MUST HAVE DR ORDER
• Restraints are used to
– restrict a person’s freedom of movement
– prevent a person from reaching parts of his or
her body
– confine a person to a bed or a chair
– prevent movement of a specific body part
• Restraints can be either
– Physical or
– Chemical
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Restraints
• A physical restraint can be applied to
– Wrists
– Ankles
– Chest
– Waist
– Arms or Elbows
• Some types of chairs or attachments to chairs can act
as restraints
• The side rails of beds or tightly tucked sheets can act
as restraints Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Vest or POSEY
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Wrist or Ankle Restraint
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Lap buddy and Chairs with Tables
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Side Rail Entrapment
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Chemical Restraints
• A chemical restraint is any medication that alters a
person’s mood or behavior
• Chemical restraints are sedatives or tranquilizers
• Chemical restraints are used to calm an anxious,
combative (physically aggressive), or agitated (very
upset) person
• Chemical restraints are not used for staff convenience
• Chemical restraints should not be used in so high a
dose as to make the person sleepy or unable to
function in a normal fashion
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Using Restraints
• Examples of some situations where the
use of a restraint may be appropriate:
– A person is at risk for falling but will
not stay in his bed or a chair and will
not call for help
– A person may wander away from the
facility
– A person tries to remove tubing needed
for medical treatment
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Complications Associated With Using
Restraints
• Strangulation, which can lead to death
• Bruises, nerve damage, and skin abrasions
• Permanent tissue damage as a result of impaired
blood flow
• Broken bones
• Pneumonia, pressure ulcers, and blood clots
• Mental effects such as agitation, increased
confusion, humiliation, and embarrassment
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Applying Restraints
• Only a doctor can order a restraint for a patient
or resident
• Always follow your facility’s policies regarding the
application and use of restraints
• Only a registered nurse (RN) or a licensed
practical nurse (LPN) can apply a restraint
• Nursing assistants are responsible for providing
care for the person while he or she is restrained
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Quick Release KNOT & other safety tips
• To make a quick release knot
– Make a regular overhand knot
– Slip a loop through the first loop
– NEVER tie any restraint to the side rail
– all restraints must be tied to the bed
frame
– Never have the patient completely flat in
bed with a restrain on
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What Should you Document --• Type of restraint
• Time of restraint application
• Patients response to the restraint
• Position of the patient
• Food or fluids taken
• Elimination results
• Skin care given
• ROM which were performed while restraints were in
place
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End of Presentation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins