Is this considered a restraint?

  1. Scenario: An older adult client who is confused, but has a blood draw order. Is it a restraint to take a blanket/sheet and tuck it around their arms to keep the arms from moving?

    Luckily, when I had this situation, I was able to find some help on the floor from another tech. I know in newborn nursery they do this for babies during circumcision. I was just wondering if this would be considered a restraint on an adult?
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    About Firefly29

    Joined: Oct '16; Posts: 5; Likes: 4

    13 Comments

  3. by   not.done.yet
    Yes. That is a restraint and subject to all the laws surrounding them.
  4. by   Davey Do
    Agreed.

    Easily remedied by completing a form for restraint due to a medical procedure by an LIP- an RN- and signed off by a physician.
  5. by   chare
    Whether it's a restraint, or not, depends. If the patient consents, and being confused doesn't necessarily negate her or his ability to consent, then no, this isn't a restraint. If he or she isn't able to consent it wouldn't matter if you secured them with a sheet or had another tech physically hold them, it would be considered a restraint.

    As Davey Do suggested, if there is ever any doubt, it's always best to get the order.
  6. by   MunoRN
    It's a restraint to facilitate a procedure, but not an ongoing restraint, and generally when people ask "does this count as a restraint" they are referring to ongoing restraints since that is what requires a specific provider order, specific charting requirements, etc. Restraint to facilitate a procedure, which also applies to the immediate recovery phase such as in PACU, does not require a specific order as a regulatory requirement although facilities are free to add this requirement on their own.
  7. by   MunoRN
    From CMS restraint guidance:
    A medically necessary positioning or securing device used to maintain the position, limit mobility, or temporarily immobilize the patient during medical, dental, diagnostic, or surgical procedures is not considered a restraint.
    https://www.cms.gov/Regulations-and-...ds/R37SOMA.pdf
  8. by   Firefly29
    Thank you all for your responses. Glad I asked, better to be safe than sorry.
  9. by   chare
    Quote from MunoRN
    It's a restraint to facilitate a procedure, but not an ongoing restraint, and generally when people ask "does this count as a restraint" they are referring to ongoing restraints since that is what requires a specific provider order, specific charting requirements, etc. Restraint to facilitate a procedure, which also applies to the immediate recovery phase such as in PACU, does not require a specific order as a regulatory requirement although facilities are free to add this requirement on their own.
    I have to disagree. When CMS refers to restraints to facilitate a procedure, I don't think they envisioned taking a "blanket/sheet and tuck[ing] it around their arms to keep the arms from moving" or "find[ing] some help on the floor from another tech" to help you. Regardless of intent, in either scenario you have physically restrained the patient. In the scenario described I find it particularly concerning that some would see using a sheet as a restraining device.
  10. by   brownbook
    Maybe I'm confused. But for a 1 - 2 minute blood draw it's considered a restraint if a coworker helps hold the arm steady, or a sheet is wrapped around the arm? As I said for maybe a whole 2 minutes!!!!!

    Is that really what we're talking about here? And you're supposed to get a LIP and doctor's order???????

    As to patient consent, years ago I was told blood draws, IV starts, minor routine stuff, did NOT need a patient's signed consent, they were covered under the boilerplate admission paperwork the patient signed. Of course that does not mean you can do anything if the patient says no.
    Last edit by brownbook on Jun 25
  11. by   MunoRN
    Quote from chare
    I have to disagree. When CMS refers to restraints to facilitate a procedure, I don't think they envisioned taking a "blanket/sheet and tuck[ing] it around their arms to keep the arms from moving" or "find[ing] some help on the floor from another tech" to help you. Regardless of intent, in either scenario you have physically restrained the patient. In the scenario described I find it particularly concerning that some would see using a sheet as a restraining device.
    It's hard to discern exactly what technique was used, but using a sheet or more commonly a pillowcase is not necessarily inappropriate and for immobilzing an arm during a lab draw is actually safer than directly holding the arm.

    Often when someone is holding an arm there is more shear and often oppositional shear, and oppositional shear plus old man arm skin generally equals skin tear. A pillowcase over part of the arm held down on either side more evenly distributes the pressure and doesn't create two different directions of shear. There are certainly some patients wear a pillowcase is no match for them and you'll just have to hold the arm.
  12. by   MunoRN
    Quote from brownbook
    Maybe I'm confused. But for a 1 - 2 minute blood draw it's considered a restraint if a coworker helps hold the arm steady, or a sheet is wrapped around the arm? As I said for maybe a whole 2 minutes!!!!!

    Is that really what we're talking about here? And you're supposed to get a LIP and doctor's order???????

    As to patient consent, years ago I was told blood draws, IV starts, minor routine stuff, did NOT need a patient's signed consent, they were covered under the boilerplate admission paperwork the patient signed. Of course that does not mean you can do anything if the patient says no.
    It's up to facilities to decide what requires written consent and what doesn't but really everything we do requires consent, just not always written.

    It sounds as though in the situation described the patient is not competent to make their own decisions and which case overall treatment has been consented to buy a POA or falls under medical necessity.
  13. by   calinurse60
    "to keep the arms from moving" should tell you that yes it is a form of restraint. Always cover yourself legally, because you never know who is watching. These days people have cameras everywhere, and don't be surprised to find out that your little confused patient just may have a family member who sets something up to record audio and/or video while they are gone. Always assume someone is watching, and always cover your butt legally. Better safe than sorry - in all situations.
  14. by   MunoRN
    Quote from calinurse60
    "to keep the arms from moving" should tell you that yes it is a form of restraint. Always cover yourself legally, because you never know who is watching. These days people have cameras everywhere, and don't be surprised to find out that your little confused patient just may have a family member who sets something up to record audio and/or video while they are gone. Always assume someone is watching, and always cover your butt legally. Better safe than sorry - in all situations.
    Why do you think it would be a problem if "someone is watching"?

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