Question on the use of restraints

  1. Where can I find a list of exactly what is considered a medical restraint and what isn't? If I'm reading it correctly, the Joint Commission says that basically anything that restrains a person from moving freely is a restraint but that just seems too vague to me. Specifically, I'm trying to find information about the safety and legal issues regarding use of a gait belt to restrain a disoriented and high fall risk patient to a chair.

    Thank you!
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    About Wicked Wahine, RN

    Joined: May '07; Posts: 105; Likes: 138
    from US
    Specialty: 6 year(s) of experience in Woundcare


  3. by   oldladyRN
    A gait belt. Don't think I've seen one of those used as a restraint before, although I see something new every day.

    Yes, definitely a restraint. Instead of focusing on the gait belt, focus on what you're doing with it and substitute other items, asking yourself the same question. Would it be a restraint if I used a necktie instead of a gait belt? Yes. What about if I used a bedsheet? Yes, still a restraint.

    Restraints have gotten a bad rep over the years because people were using them as a babysitter and not assessing the patient on a regular basis. Because of that, people scooched down in the bed and strangled in their posey vests and got their heads caught between bedrails and were not found for a long time. Sometimes they were used to prevent falls but some progressed to being a convenience item.

    Many, many facilities talk about the patient's "right to fall". I'm not sure I agree with that way of thinking, because it flies in the face of safety when you're talking about a frequent faller (confused, impossible to re-orient).

    My dear sister has been a nurse for 30+ years. She has worked LTC for most of those years and often tells stories about patients being tied into their wheelchairs with a sheet (so that they wouldn't tip forward and fall out of the WC) at the nurse's station while the nurses finished their charting. The patients would fall asleep, be put to bed and that was the end of that. No one called it a restraint.

    Getting back to your original question, I don't know where any sort of comprehensive list can be found.

  4. by   kajunnurse
    In my state I am not aware of a certain list or a place to retrieve a list. In our facility we consider the following as restraints: SR up x2, seat belt or any other belt that the resident is unable to release them self, Geri chair (if unable to get out of chair without assistance), tilt wheel chair, and the other obvious devices such as wrist restraints, pelvic restraints etc. Basically anything that keeps a person confined and they are not able to release or get out of it themselves with out staffs assistance.
  5. by   Wicked Wahine
    What if the facility had a list of acceptable restraints including wrist restraints, freedom splints, bedrails x2, etc when ordered for safety (but not for falls, which is something I have a big problem with when someone is not able to be oriented and will without a doubt attempt to get up fall, but I digress). But what if this list doesn't specifically include using a gait belt as a means to strap someone to a chair or any type of lap belt for that matter. Does it matter if a facility lists something as being a restraint or not when in reality, it is something that obviously restrains a patient? I am also wondering if using a gait belt around someone's waist in a chair is even safe, if that person is then left alone in the room for, say, an hour.
  6. by   loriangel14
    Leaving them alone in the room wouldn't be safe. Where I work you have to assess the pt q15 and document if they are in restraints. usually they get parked where we can easily see them if they are restrained.
  7. by   mykrosphere
    list or no list, using a gait belt to tie someone to a chair is obviously a restraint.
    i have seen this in ltc.
    where i work now, pretty much everything is a restraint except for we can have siderails X3, and can use mitts on someone.
    both of which also can also be considered a restraint.
    we mostly utilize 1:1 sitters and bed alarms, but our pt. load is not like it is in ltc either, averaging 4-5 pts.
    i hate restraints and pts seem to get even more agitated with them on.
    there are all sorts of things that could go sure in the case of the gait belt tied to a chair unsupervised for an hour is no exception.
  8. by   aura_of_laura
    Absolutely that's a restraint. Check with your state guidelines - usually the use and definition of restraints is determined at a state level. Restraints include anything that restricts a patient, whether it's a physical restraint or the use of chemicals. Your facility should have to document and trend all restraints for JCAHO, if your facility is accredited.
  9. by   CoffeeRTC
    If it restricts movement it is a restraint. A reclining chair can be called a restraint. There is no magic list.
  10. by   elkpark
    There is no "list" anywhere because the CMS and JCAHO rules (and most state rules/regs) state that anything that restricts the client's freedom of movement is a restraint. The point isn't what item is being used to do that, it's that the freedom of movement is being restricted in some way, by something. Once you're restraining someone, the issue is simply whether it's a medical restraint or a behavioral restraint. Those are defined pretty clearly in the CMS and JCAHO and state rules, and in most facilities' policies.

    Using a gait belt to secure someone to a chair would clearly count as a restraint.
  11. by   Wicked Wahine
    Thank you, everyone. I'm glad to see that I'm not the only one who considers something that restricts someone's movements (I.E. "restraining" them, lol) as restraints.
  12. by   rachelgeorgina
    When I worked in aged care we had an elderly, demented male patient that was a huge, huge falls risk (walk x2 assist with four arm support frame ONLY) and would often try and leave his chair to get up and walk (& thus fall.) We used what I assume is called a gait belt around him/the chair to keep him in the chair and prevent him from falling over.

    This made me so sad because the staff would just leave him there for hours, unnoticed or observed when the facility policy stated other interventions needed to be implemented each time BEFORE resorting to restraint and that he needed to be reassessed q15min. It never happened.

    He used to manoeuvre himself around, restrained in his chair by "hopping" with his bottom. It was awful.
  13. by   fuzzywuzzy
    I got yelled at after an A&Ox3 resident got annoyed when his recliner kept falling down and asked me to prop up the legs with the trash can, because that's a restraint, I guess.
  14. by   qt2168
    Ok so someone explain this. At my hospital we have freedom splints that go around the pts elbows that stop them from bending their elbows to pull out iv tubing. This is called an alternative at my hospital and not a restraint. Is this wrong?