Are mittens a restraint at your facility?

[in2ICU]

Hi All,

Are mittens, used alone, considered a restraint at your facility?

I have worked at a couple of major magnet-designated medical centers and they have opposing views on classifying the use of mittens as a restraint. One says they are, and the other calls them a restraint alternative.

Just to be clear, I mean the boxing glove looking mittens that have velcro at the wrist to hold them on the patient's hands. These are NOT tied down in any way shape or form and the patient can still move his/her arms. Specifically, I use these in the ICU to keep patients who are sedated from pulling their ET tube or central line because obviously they are not thinking clearly!

Please let me know what your hospital's stance is... thanks!

[CapeCodMermaid, RN]

Mittens are considered restriaints in my facility if they are tied down. I work on a neuro floor and frequently we will put them on our patients without them being tied down. Many of our patients are able just to stick on hand under an arm and pull them off or shake them off, but some are unable to think in that manner and they work great for them. We don't need a MD order and because most rehabs in the area won't take patients who have been restrained for any reason it makes it easier to keep our access devices (that they won't have in rehab) safe while still being able to get the patient to rehab.

So basically you're saying you don't call them restraints because a SNF might not admit them? Yikes. In Massachusetts in long term care, the DPH considers anything that restricts access to one's body a restraint. So, yes, mittens are restraints.

[highlandlass1592, BSN, RN]

Last 4 facilities I've been at, mittens were NOT considered restraints but alternatives. I checked the Joint Comission website and couldn't find them mentioned specifically.

[travkitty]

At my hospital (a Magnet one at that), they are not considered restraints if used on their own. If we have 4 rails up, have to do 2-4 points, blah blah, then they are included. But, if a confused LOL is pulling at her oxygen, tubes, or trying to smack us, we can apply them without an order.

[blueheaven]

As long as the mittens are not not tied to the bed and the patient has full use of upper extremities...NO they are not a restraint. The minute they are tied to the bed, they become a restraint

[CapeCodMermaid, RN]

I think everyone needs to check their own P&P book. Clearly the rules differ by state and by the type of facility.

[PugRN]

That's not entirely correct. There are four criteria for establishing whether or not a mitt is a restraint, and if the mitt meets any of them then it is a restraint:

1) If they are attached or pinned to something else, or used with other restraints.

2) Immobilize the hands or fingers.

3) Are so bulky they significantly reduce the patient's ability to use their hands.

4) they cannot be easily removed in the same manner they were applied by staff with consideration for the patient's condition. (The same condition that makes 4 side-rails a restraint under some conditions).

Almost all of the mitts that I've seen in use at least meet that 4th requirement, and most meet that third feature as well.

[smf0903]

JC was just at our facility and we were informed that mitts are restraints.