Is tape considered a restraint in this situation?

[TheCatsMeow, RN]

Hey all,

I'm an RN at an outpatient dialysis unit. We've had cases where patients will raise their access arm or move in some way causing an infiltration or even needle dislodgement because they forget that there are needles in their arm. Some staff have taken the approach of placing one loose piece of tape over the patient's wrist and to the dialysis chair for patients who do this frequently. Patient's with new accesses have even requested a piece of tape over their wrist to "remind" them not to move that arm. Of course, this is not done with all patients, just a handful and they can refuse it if they wanted. No one is forcibly taping their wrist and only the access arm wrist is taped. The other wrist is completely mobile (and honestly, so is the taped wrist...I've seen patients slide their wrist out from under the tape or just lift their wrist and detach the tape). 

Recently, our unit manager has told us that this is considered a restraint and it is illegal if we do this. I was under the impression that a physical restraint immobilizes or restricts movement of a body part, limb, ect and cannot be easily removed by the patient. Does one piece of tape loosely placed over the wrist qualify as a restraint? 

 

[amoLucia]

It's been some time for me, but I'd say this is prob something only your regulatory agency could answer. And then remember, it could all fall on the whims of an individual reviewer. Esp it pt is having a bad day, and the pt could NOT demonstrate loosening it when asked to do so.

Make sure it's care-planned. And team conferenced. And family & PMP aware. Like all the things you'd HAVE to do if you were treating it just like some other type of physical/chemical restraint per facility P&P.

I understand your best interests for the pts safety. So wise for you to ask.

And welcome to AN.

[MunoRN, RN]

This isn't considered a restraint per CMS guidelines for a couple of reasons; first it's to facilitate a procedure, and second it's only one upper limb with an non-paralyzed contralateral limb.  

[amoLucia]

TY again for your info.

[Hoosier_RN, MSN]

In a dialysis clinic, it may vary by state. In Indiana, its considered a restraint and will get you an IJ. Happened recently in a Davita clinic, but we all know about it, as it came down word of mouth. Fresenius has it spelled out in its company policy. 

[Chisca, RN]

In Tennessee it is as Muno describes. Procedurally necessary.