restraints. current cms regulatory requirements and jcaho requirements staff involved with applying,...

RESTRAINTS

Current CMS Regulatory Requirementsand

JCAHO Requirements

•Staff involved with applying, assessing/monitoring &/or providing care to patients with restraints must

be trained and demonstrate competency on an ANNUAL BASIS to care for a patient in restraints

Definition of a Restraint

• Restraint is any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely

• A drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.

Saint Joseph Health System

Philosophy • Minimize restraint use• Maximize safety• Prefer less restrictive

interventions• Discontinue at earliest

possible times• Use only in clinically

appropriate and justified situations

Types of Restraint and Clinical Areas of Use

Vest Restraint All Clinical Nursing Areas

Soft Cloth Extremity All Clinical Nursing Areas

4 raised side rails All Clinical Nursing Areas

Chemical All Clinical Nursing Areas

Classification of Restraint• Medical • Behavioral Management• Chemical • Side rails

What is a Medical Restraint?

A medical restraint is used to manage a patient who presents a risk of harm to themselves and/or others and/or interferes with medical/surgical healing

Medical Restraint Flow sheet Monitoring and Documentation

Monitor at least every hour the patient’s:

• Physical and emotional well being• Rights, dignity and safety are

maintained• Restraint has been appropriately

applied• Behavior that necessitates less

restrictive methods or continuation of restraints or removal of restraints (nurse only)

Document every 2 hours

• That toileting, food and fluids are offered

• Distal circulation and skin integrity of involved extremities

• ROM/Rotate restraint sites, if patient condition permits

• Use appropriate codes listed on flow sheet

What is a Behavioral Restraint?

A behavioral restraint is used only in emergencies when nonphysical interventions are ineffective or not viable and when there is imminent risk of a patient physically harming self or, staff or others.

Side RailsSide rails are considered a medical restraint when used to:•Restrict or prohibit movement•Restrict access to the patients body

Side Rails (Cont.)Side rails on a hospital bed are not required. Side rails on a stretcher are not considered a

restraint. 3 side rails are not considered a restraint.4 side rails ARE a restraint, unless patient is:

– Unable to move– Requesting side rail(s) as a mobility aid– Requesting side rail(s) as reminder not to get out

of bed.– Unconscious/sedated.– Recovering from anesthesia.– Using for support purpose (i.e. obese patient)– On the Total Care Sp02RT in the rotational mode.

Reporting Requirements

• Injury or death of a patient while in restraints are to be reported to the House Administrator immediately.

Reminder: Remove all physical restraints with the initiation of a Code Blue

Transporting a Patient in Restraints

• Keep the patient in restraint(s) when transporting to another department (i.e. nursing unit to radiology) unless other wise indicated.

ProperApplication of a

Restraint

(Add padding to support body part as needed)

Correct placement and position of a restraint

(secure to the bed frame using the quick release

buckle)

Correct placement and position of a restraint

(secure to the bed frame)

Incorrect placement and fastening of restraint

(tied to the bed frame and side rail)

Incorrect use of a restraint

(tied in knot instead of quick release buckle)

Help me, I’m choking!!!

Incorrect use of Posey (never attach straps to

head of bed)

Has anyone seen my

non-skid foot wear?

Wheelchair

• Click Here to Begin Restraint Test for Radiology Tech