Promoting safety in health care environment
Reduction of physical hazards
Table of Contents
Introduction
In healthcare settings, the use of restraints is sometimes necessary to ensure the safety of patients and others. However, restraints should be used as a last resort when all other methods have failed. This article provides comprehensive guidelines on the application of restraints, emphasizing the importance of proper techniques, ethical considerations, and the need for continuous monitoring.
The Need for Application and Types of Restraints
Understanding the Need for Restraints
Restraints are used to prevent patients from harming themselves or others. They are employed in situations where patients exhibit behaviors that could lead to injury or when they interfere with necessary medical treatments. It is crucial to communicate the need for restraints to the patient’s family and friends to ensure they understand the rationale and the safety it provides.
Types of Restraints
- Physical Restraints: These include devices like belts, straps, and jackets used to limit a patient’s movement.
- Chemical Restraints: Medications administered to control behavior and restrict movement.
- Environmental Restraints: Modifications in the patient’s environment to restrict movement, such as locked doors or enclosed beds.
- Mechanical Restraints: Devices attached to the patient’s body to restrict movement, such as wrist or ankle restraints.
General Guidelines for Restraint Application
Using Restraints as a Last Resort
Restraints should only be used after all other methods have failed to keep the patient safe. This includes verbal de-escalation techniques, environmental modifications, and the involvement of family members or caregivers.
Selecting Safe and Appropriate Restraints
Choose restraints that are appropriate for the patient’s size, build, and weight. Ensure that they do not interfere with normal circulation or cause undue discomfort.
Applying Restraints with Care
- Restraints should not be applied too tightly. They should be snug enough to prevent the patient from removing them but not so tight as to cause pain or restrict circulation.
- Ensure that the patient can assume a normal body posture. Assistance should be given to maintain comfort and proper alignment.
Monitoring and Observing Restraints
- Observe the restraint every 20-30 minutes to prevent complications such as pressure ulcers.
- Perform circulation and neurological exams to check for color, sensation, temperature, motion, and capillary refill in the area distal to the restraint.
- Restraints should be removed at least every two hours to allow for muscle exercise and circulation.
Procedure for Applying Restraints
Attempting Restraint Alternatives
Before applying restraints, attempt alternative methods to protect the patient and others from harm. These can include environmental modifications, increased supervision, and engaging the patient in calming activities.
Assessing the Need for Restraints
- Obtain a doctor’s order and assess the type of restraint needed.
- Check with the nurse to ensure that the use of restraints is necessary and that an order has been obtained or will be obtained as soon as possible.
Explaining the Procedure
- Explain to the patient and their family the rationale for the application of restraints. Clear communication helps reduce negative perceptions and anxiety.
Performing Hand Hygiene
Ensure proper hand hygiene and observe infection prevention procedures to prevent the transmission of microorganisms.
Using Cotton Pads
Use appropriate cotton pads before applying restraints to maintain comfort and prevent skin breakdown.
Specific Types of Restraints
Ankle and Wrist Restraints
- Preparation: Wrap the wrist or ankle with gauze at least three times to create a secure base.
- Application: Prepare a figure-of-eight with the bandage, placing the wrist or ankle in the loops. Pull the ends to make it firm and tie to the bed frame. Ensure the knot is tight enough to prevent slipping but not so tight as to cause discomfort.
Finger Restraint
- Preparation: Assess baseline hand and finger circulation.
- Application: Place the patient’s hand inside a stockinette or commercial mitten with the palm facing down. Secure the stockinette by applying tape around the wrist.
- Monitoring: Assess circulation shortly after application and at regular intervals.
Mummy Restraint
- Preparation: Open a blanket or sheet on a flat surface, folding one corner towards the center.
- Application: Place the child on the blanket in a supine position. Secure the child by wrapping the blanket around the shoulders and chest, folding the lower part over the body, and securing it.
Jacket Restraint
- Preparation: Assist the patient to a sitting position or roll them side to side if they cannot sit.
- Application: Place the jacket over the patient’s clothing, secure it at the back, and adjust for comfort. Ensure the restraint does not compromise breathing or circulation.
- Securing: If in bed, secure the ties to the movable part of the mattress frame. If in a chair, cross the straps behind the chair and secure them to the chair’s lower legs.
Monitoring and Documentation
Regular Monitoring
- Assess the client 15 minutes after the initiation of restraints, paying special attention to emotional status, safety of restraint placement, and neurovascular status.
- Assess restraints and skin integrity every 30 minutes. Release restraints at least every 2 hours to allow for muscle exercise and circulation.
Proper Documentation
- Document the type of restraint applied, time of application, goal for its application, client’s response, time of removal, and any skin care given.
- Report any changes in the patient’s condition to the nurse. Proper documentation ensures that the use of restraints is transparent and accountable.
Hazards of Restraints
Psychological and Emotional Effects
- Feelings of humiliation, loss of dignity, and increased stress.
- Potential for depression, withdrawal, and isolation.
- Increased agitation, hostility, and learned dependence.
Physical Effects
- Development of pressure ulcers and skin irritation.
- Obstructed circulation and muscle atrophy.
- Increased risk of respiratory infections, urinary tract infections, and decreased mobility.
Responsibilities of the Nurse
- Assessing the Need for Restraints: Ensure that restraints are applied only when necessary for the safety and well-being of the client or others.
- Communicating with the Patient and Family: Explain the needs, risks, and benefits of restraints before application.
- Complying with Policies: Follow hospital policies and guidelines for the use of restraints.
- Ensuring Patient Safety: Arrange for adequate assistance, apply the least restrictive devices, and maintain close observation.
- Documenting Use: Keep accurate records of restraint use for inspection and review.
Nursing Care of the Patient
- Call Light Within Reach: Ensure the patient has a means to call for assistance.
- Regular Release: Release restraints every two hours to allow for movement and circulation.
- Hygiene and Toileting: Assess and provide for hygiene and toileting needs regularly.
- Proper Tying: Secure restraints to prevent interference with circulation or causing pressure on a nerve.
Other Safety Devices
Introduction
In healthcare environments, patient safety is of paramount importance. Alongside restraints, several other safety devices play crucial roles in preventing falls and injuries. This article explores the applications, benefits, and usage guidelines of side rails, grab bars, ambularms, and non-skid slippers, providing comprehensive information on how these devices contribute to patient safety.
Side Rails
Purpose and Usage
Side rails, also known as bed bars, are installed along the sides of a bed to prevent patients from falling out. They are particularly beneficial for postoperative patients, unconscious or semiconscious individuals, those who are mentally disturbed or sedated, as well as for blind patients, children, and the elderly. Side rails can be adjusted up or down based on the patient’s needs and convenience.
Benefits of Side Rails
- Aiding in Turning and Repositioning: Patients can use side rails to help turn from side to side in bed.
- Providing Support: Side rails offer a hand-hold for getting into or out of bed, and support when standing up.
- Enhancing Comfort and Security: They provide a feeling of comfort and security for patients.
- Reducing Fall Risks: Side rails reduce the risk of patients falling out of bed during transport.
- Accessibility: They provide easy access to bed controls and personal care items.
Considerations for Side Rails
- Proper Installation: Ensure side rails are securely attached to prevent accidents.
- Monitoring: Regularly check that side rails are functioning correctly and not causing any harm.
- Patient Education: Educate patients on how to use side rails effectively for their safety.
Grab Bars
Purpose and Usage
Grab bars, also known as safety rails or handrails, are mounted on walls, ceilings, or floors to assist individuals with weakened mobility. They are crucial for elderly or disabled individuals, helping them maintain balance, reduce fatigue, and prevent falls. Grab bars are commonly installed in high-risk areas like bathrooms, hallways, and near toilets and showers.
Benefits of Grab Bars
- Maintaining Balance: Grab bars help individuals maintain their balance while standing or moving.
- Preventing Falls: They provide something to hold onto in case of a slip or fall, reducing the risk of injuries.
- Enhanced Mobility: Grab bars facilitate safer navigation in rooms and facilities.
- Comfort and Security: They offer a sense of security and support for weakened or disabled individuals.
Considerations for Grab Bars
- Secure Installation: Ensure grab bars are firmly mounted to support the user’s weight.
- Regular Inspection: Check for stability and wear and tear regularly.
- Appropriate Placement: Install grab bars in locations where they are most needed, such as bathrooms and hallways.
Ambularms
Purpose and Usage
Ambularms are an alternative to restraints, designed to prevent falls by signaling when a patient’s leg is in a dependent position. Worn on the leg, the Ambularm device triggers an audio alarm when the patient starts to walk, crawl, or kneel, alerting caregivers to potential falls.
Benefits of Ambularms
- Fall Prevention: Ambularms help prevent falls by alerting caregivers when a patient attempts to move unassisted.
- Monitoring Mobility: They provide real-time monitoring of a patient’s movements.
- Non-Restrictive: Unlike traditional restraints, Ambularms allow more freedom of movement while still ensuring safety.
Steps to Use Ambularms
- Explain to the Patient and Family: Educate them on the purpose and function of the Ambularm device.
- Measure the Patient’s Thigh: Determine the appropriate size based on thigh circumference.
- Test the Device: Check the battery and alarm function before application.
- Apply the Leg Band: Place the leg band just above the patient’s knee and secure the battery in place.
- Deactivate for Ambulation: Temporarily disable the alarm when assisting the patient with movement.
Non-Skid Slippers
Purpose and Usage
Non-skid slippers are designed to prevent slipping and provide comfort for patients. They have grooved skid-resistant soles and are often used in healthcare settings to enhance patient mobility and safety. These slippers are especially beneficial for elderly individuals and those with conditions such as arthritis, edema, and diabetes.
Benefits of Non-Skid Slippers
- Preventing Slips: The grooved soles reduce the risk of slipping on dry floor surfaces.
- Comfort: The soft, comfortable materials provide relief for patients with foot conditions.
- Easy to Wear: The expanded foot opening allows easy placement on the feet by users or caregivers.
- Stability: The back-heel collar helps keep the slippers securely on the feet.
Considerations for Non-Skid Slippers
- Proper Fit: Ensure the slippers fit well to avoid discomfort and ensure effectiveness.
- Regular Cleaning: Maintain hygiene by regularly cleaning the slippers.
- Inspection: Check the soles for wear and replace them if the grip is compromised.
Conclusion
The application of restraints and safety devices in healthcare settings must be handled with utmost care and consideration. Restraints should only be used as a last resort, with continuous monitoring and regular reassessment to ensure the patient’s safety and comfort. Proper communication with the patient and their family, adherence to guidelines, and thorough documentation are essential components of effective restraint use. Additionally, other safety devices like side rails, grab bars, Ambularms, and non-skid slippers play a vital role in preventing falls and ensuring patient safety.
FAQs
What are the types of restraints used in healthcare?
There are four main types of restraints used in healthcare: physical restraints, chemical restraints, environmental restraints, and mechanical restraints. Physical restraints include belts, straps, and jackets. Chemical restraints involve medications to control behavior. Environmental restraints modify the patient’s surroundings, such as locked doors. Mechanical restraints are devices attached to the patient’s body, like wrist or ankle restraints.
When should restraints be used in a healthcare setting?
Restraints should only be used as a last resort when all other methods have failed to prevent a patient from harming themselves or others. This includes using verbal de-escalation techniques, environmental modifications, and involving family members or caregivers.
What are the benefits of using side rails on hospital beds?
Side rails help prevent patients from falling out of bed, aid in turning and repositioning, provide a hand-hold for getting in and out of bed, offer a feeling of comfort and security, reduce the risk of falling during transport, and provide easy access to bed controls and personal care items.
How do grab bars help patients in healthcare settings?
Grab bars assist weakened, disabled, or elderly individuals in maintaining balance, reducing fatigue while standing, redistributing weight comfortably, and providing support in case of a slip or fall. They are especially useful in high-risk areas like bathrooms and hallways.
What is an Ambularm and how does it work?
An Ambularm is a device worn on the leg that signals when the leg is in a dependent position. It alerts caregivers when a patient who should not be walking is attempting to do so, helping to prevent falls. The device triggers an audio alarm when the patient begins to walk, crawl, or kneel.
Why are non-skid slippers important for patients?
Non-skid slippers have grooved, skid-resistant soles designed to prevent slipping on dry floor surfaces. They provide comfort and support, relieve pressure for diabetic patients, and help elderly individuals with arthritis or edema to walk safely without pain.
How should restraints be monitored once applied?
Restraints should be observed every 20-30 minutes to prevent complications. Regular circulation and neurological exams should be performed to check for color, sensation, temperature, motion, and capillary refill in the area distal to the restraint. Restraints should be removed at least every two hours to allow for muscle exercise and circulation.
What are the potential hazards of using restraints?
Using restraints can lead to psychological effects such as feelings of humiliation, loss of dignity, increased stress, and depression. Physical effects include the development of pressure ulcers, obstructed circulation, muscle atrophy, respiratory infections, urinary tract infections, and increased risk of falls and injury.
How should the use of restraints be documented?
Documentation should include the type of restraint applied, time of application, goal for its application, patient’s response, time of removal, and any skin care given. Changes in the patient’s condition should be reported to the nurse. Proper documentation ensures transparency and accountability.
What are the responsibilities of the nurse regarding restraints?
Nurses are responsible for assessing the need for restraints, ensuring they are used as a last resort, explaining the reasons to the patient and family, complying with hospital policies, ensuring patient safety, arranging adequate assistance, applying the least restrictive devices, maintaining close observation, attending to the patient’s needs, and documenting the use of restraints.