legal issue with restraints

RNinSoCal · Oct 19, 2006

Hello,

Have you thought of making a form with checkboxes. Our form is computerized but it is a check box form. It starts with assessment: reason for restraints, medical condition, emotional/psychological condition, behavior , whether alternative methods were tried prior to restraints and was MD or pt family notified. (If night shift we notify MD in am) The intervention form has boxes for skin checks/circ check, hydration, elimination, ROM, type of restraint, pt response. We chart assessment once per 8 hours, intervention every 2 hours. MDs sign restaint form Q 24 hour and the charge nurse makes sure form is filled out, in chart and flagged for MD to sign.

It makes it slightly less tedious and easy for everyone to see if it has been done or not.

Hope that helps. And YES it is illegal to restrain without documentation of reason. It is wrongful imprisonment I think, maybe a legal nurse knows for sure.

trixytop4 · Oct 20, 2006

We have a great system for documentation. Of course we are a small hospital that is still in the age of hand writing everything. No computer charting. My problem is getting it through to these nurses the legal ramifications of false imprisonment with restraints. I tried to look for some actually cases and can not find any.

Daytonite, BSN, RN · Oct 21, 2006

i would suggest that you have a blow up or handouts made of the following federal law which deals with restraints:

title 42 public health

chapter iv centers for medicare & medicaid services, department of health and human services

part 482--conditions of participation for hospital

sec. 482.13 condition of participation: patients' rights.

(e) standard: restraint for acute medical and surgical care. (1) the patient has the right to be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline,

convenience, or retaliation by staff. the term ``restraint'' includes either a physical restraint or a drug that is being used as a restraint. a physical restraint is any manual method or physical or mechanical

device, material, or equipment attached or adjacent to the patient's body that he or she cannot easily remove that restricts freedom of movement or normal access to one's body. a drug used as a restraint is a medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychiatric condition.

(2) a restraint can only be used if needed to improve the patient's well-being and less restrictive interventions have been determined to be ineffective.

(3) the use of a restraint must be--

(i) selected only when other less restrictive measures have been found to be ineffective to protect the patient or others from harm;

(ii) in accordance with the order of a physician or other licensed independent practitioner permitted by the state and hospital to order a restraint. this order must--

(a) never be written as a standing or on an as needed basis (that is, prn); and

(b) be followed by consultation with the patient's treating physician, as soon as possible, if the restraint is not ordered by the patient's treating physician;

(iii) in accordance with a written modification to the patient's plan of care;

(iv) implemented in the least restrictive manner possible;

(v) in accordance with safe and appropriate restraining techniques; and

(vi) ended at the earliest possible time.

(4) the condition of the restrained patient must be continually assessed, monitored, and reevaluated.

(5) all staff who have direct patient contact must have ongoing education and training in the proper and safe use of restraints.

(f) standard: seclusion and restraint for behavior management. (1) the patient has the right to be free from seclusion and restraints, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. the term "restraint'' includes either a physical restraint or a drug that is being used as a restraint. a physical restraint is any manual method or physical or mechanical device, material, or equipment attached or adjacent to the patient's body that he or she cannot easily remove that restricts freedom of movement or normal access to one's body. a drug used as a restraint is a medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychiatric condition. seclusion is the involuntary confinement of a person in a room or an area where the person is physically prevented from leaving.

(2) seclusion or a restraint can only be used in emergency situations if needed to ensure the patient's physical safety and less restrictive interventions have been determined to be ineffective.

(3) the use of a restraint or seclusion must be--

(i) selected only when less restrictive measures have been found to be ineffective to protect the patient or others from harm;

(ii) in accordance with the order of a physician or other licensed independent practitioner permitted by the state and hospital to order seclusion or restraint. the following requirements will be superseded by existing state laws that are more restrictive:

(a) orders for the use of seclusion or a restraint must never be written as a standing order or on an as needed basis (that is, prn).

(b) the treating physician must be consulted as soon as possible, if the restraint or seclusion is not ordered by the patient's treating physician.

(d) each written order for a physical restraint or seclusion is limited to 4 hours for adults; 2 hours for children and adolescents ages 9 to 17; or 1 hour for patients under 9. the original order may only be

renewed in accordance with these limits for up to a total of 24 hours. after the original order expires, a physician or licensed independent practitioner (if allowed under state law) must see and assess the

patient before issuing a new order.

(iii) in accordance with a written modification to the patient's plan of care;

(iv) implemented in the least restrictive manner possible;

(v) in accordance with safe appropriate restraining techniques; and

(vi) ended at the earliest possible time.

(4) a restraint and seclusion may not be used simultaneously unless the patient is--

(i) continually monitored face-to-face by an assigned staff member; or

(ii) continually monitored by staff using both video and audio equipment. this monitoring must be in close proximity the patient.

(5) the condition of the patient who is in a restraint or in seclusion must continually be assessed, monitored, and reevaluated.

(6) all staff who have direct patient contact must have ongoing education and training in the proper and safe use of seclusion and restraint application and techniques and alternative methods for

handling behavior, symptoms, and situations that traditionally have been treated through the use of restraints or seclusion.

(7) the hospital must report to cms any death that occurs while a patient is restrained or in seclusion, or where it is reasonable to assume that a patient's death is a result of restraint or seclusion.

in addition, you should also check your own state laws for any legislation regarding restraint of patients. a third thing you can do is cite the jcaho standard on restraint and seclusion (pc 10.10 through 12.190) along with specific elements of performance for each of these standards. fourth, have your written hospital policy available for people to view.

this stuff is so cut and dry and uncomfortable to most people, however, that you might want to attempt to make it palatable by turning it into some kind of game or fun fact thing, if that's possible. most nurses are harped at about this stuff, but never actually see the real laws on it. i used to laughingly talk about sending people to "nurse jail" when i was a manager for not following policy and procedure.

something else you could do is pull out some antidotal material on patients who died from either wrongful or poorly applied restraints to share. there's a few legal cases on this that are the reason these restraint laws were enacted.

trixytop4 · Oct 21, 2006

Thank you so much for your help. I truely appreciate it very much