Restraint Standards

Linda10 · Aug 10, 1998

Jeanne,

At the Acute care facility where I work the ancillary staff are all required to be familiar with the restraints and the policies governing application. We do a yearly "recert" day to keep skills polished and try to introduce new things and/or showcase one thing. This spring we showcased restraints, policies, paperwork, etc. and included ancillary staff. We include anyone who has patient contact, including housekeeping, maintenance, and volunteers. It works well. Sentiment over this restraint stuff is quite sour. Most do not understand why these new regs are required, and the paperwork is ridiculous. I guess you can see that I am among those. Do you know what was behind all this? I do a lot of reading and if the nursing home that was restraining everyone is the cause...the whole thing is ridiculous. This was one out of more than a million places. Normal state board visitations should be enough. Any feedback on this would be appreciated.

Willow · Aug 11, 1998

Hi Linda

I am a Canadian Nurse that is coming down to the States In Sept/Oct. At each of my 2 interviews I found it interesting restraints were such a large issue. In fact it was the most premiumquestion going.So, if you find what your looking for with regard to info on I wonder if you would please pass it on.

Thanks

Willow

Janis Noone · Aug 11, 1998

In re to restraints, our hospital includes how to apply and the care of the patient in both initial orientation and in the annual "mandatory" education. We do include all patient care providers so that rehab, resp, etc are included. I hear the newest focus of JCAHO is also including a look at what your organization is doing to reduce the use of restraints. Hmmm...

jaylex · Aug 19, 1998

I work @ a 98 bed restraint-free facility. At 1st I didn't think it could be done, but it's working well. That's one less thing we have to worry about. No one's apt to get injuried as a result of the use of it, such as (hung). The wanders wear an alert armband that's checked frequently for proper operation. If a resident gets away and get to an exit door the door alarm will go off. For freq fallers, we use a type of alarm attached to their garment from a device from their chair or bed that alarms if they get up. It works for us.

lisao · Aug 30, 1998

As part of our annual mandatory safety and security review, all staff who have contact with patients watched a video, produced by the informations systems dept. They had employees from various depts. of the hospital act out situations that were critical to JCAHO (i.e. restraints) The scenes were already reheorificed of course but the skits were funny and entertaining. After watching the video, each employee had to take a test, which was then turned into the nursing education dept. as proof of compliance with requirements. This was the first year they did it, and the response from the employees was very positive. Beats a boring lecture or film. Hope this helps. Lisa in IN

NurseRachet · Oct 10, 2000

We also train our staff at yearly mandatories and upon employment. We have reduced our restraint usage by using sitters and/or family members to remain with the patient. Most of our patients that are restrained are those patients having total knees and hips. The ortho surgeons do not want them falling out of bed. I think some of them would benefit from a change of pain medication. They still use demerol as their number 1 choice - which we know that is so outdated now. Oh well, we just keep trying. Good luck.

Toril Strand · Nov 21, 2000

Originally posted by JEANNE:
Hello,
I am interested to see what other hospitals are doing to meet the annual competency for restraints. At this point in time we hold annual skill labs for the nursing staff and include an aspect of restraints. My question is what are you doing to meet this requirment for the ancillary staff, such as respiratory staff, imagining and security. Any ideas would be helpful, Thanks Jeanne

Jeannie, We do an 8 hr initial class using the CPI model of management of assaultive behavior, then do recert annually with a 41/2 hr class. We stress verbal de-escalation and go up to a CPI hold, then our own internal policies take over from the CPI hold to therapeutic holds seclusion and restraints. we follow HCFA and JCAHO quidelines and Champus. We have forms that we use for orders, and nurses documentation and MD.All staff, except housekeeping and business office are trained.

[This message has been edited by Toril Strand (edited November 20, 2000).]

bayoubelle65 · Jan 6, 2001

At our hospital restraints are a part of the yearly competencies. We verify competency by written tests and demonstration. The written test is taken directly from the hospital policy on restraints and the demonstration is verified by a unit coordinator. Nursing Assistants are tested in the same way. The other ancillary staff are not tested as it is policy that nurses or assistants apply restraints. We have also developed a restrait flowsheet to ensure adequate documentation according to JCAHO guidelines that is placed on each chart daily. It is in check-off format and we have found that it has greatly improved our CQI numbers. Restraint consents are also a hot topic. We have implemented into policy that anyone going to surgery with the possibility of being on a ventilator post-opor with possible need of post-operative restraints for one reason or another, have a restraint consent signed with the operative consent. Of course there is no way to make this 100% effective, but it also has greatly affected our CQI's

Originally posted by JEANNE:
Hello,
I am interested to see what other hospitals are doing to meet the annual competency for restraints. At this point in time we hold annual skill labs for the nursing staff and include an aspect of restraints. My question is what are you doing to meet this requirment for the ancillary staff, such as respiratory staff, imagining and security. Any ideas would be helpful, Thanks Jeanne

johnboy · Jan 26, 2001

Our hospital seems to be in the Dark Ages concerning restraints (or perhaps just sticking our collective heads in the sand). I work in ICU, and it's been our interpretation that anyone needing restraints for "medical" reasons doesn't need a physicians order, although we do incorporate a 15 minute "check" area for number/type of restraints plus circulation checks on our flowsheets.

"Medical" is a much-argued, vague term, meaning anything from 99% of ventilator patients to ventriculostomy patients to "sweet Little Grandma" who gets a little loopy at night and tries to rip out her IV's. I feel we really should be getting physicians' orders and the whole shebang, but i admit, it IS nice just putting little check marks on the flow sheet without calling the physician and doing all that other paperwork. We justify by saying, "it's a medical reason, not a behavioral reason." We have JCAHO this year, so it'll be interesting to see what we'll have to do at the last minute to "comply" with JCAHO standards. Just like every other hospital I've worked at!

PedsRN3 · Jan 4, 2002

I agree with you that the "medical" need is a much argued point and is open to interpretation. I work at a children's hospital and we are preparing for our review this spring. Restraints are a big topic because we have just been told that the safety beds we use for our closed head injury patients are a form of a restraint therefore they must be a 1-1 patient. Its such a pain because of everything that goes along with the 1-1 pt such as frequent checks, md orders, etc. We can have 3-4 pts who need to be in a safety bed at any one time but unfortunately we now can't. Has anyone else run into this problem??? I would be interested in what you did regarding this!

Thanks!

Ainatsue · Mar 15, 2005

Hello,
I am interested to see what other hospitals are doing to meet the annual competency for restraints. At this point in time we hold annual skill labs for the nursing staff and include an aspect of restraints. My question is what are you doing to meet this requirment for the ancillary staff, such as respiratory staff, imagining and security. Any ideas would be helpful, Thanks Jeanne

I have just started setting up a program to educate our nurses. So far we have a written test dealing with the policy/procedures then we are having a "hands on" portion. The most difficult thing I have found, of course, is compliance and getting people to complete things. If anyone can give me ideas I would greatly appreciate it. We have a toolbox currently set up with the restraints we use in house for people to demonstrate. It is bright red and can be brought to the wards for use.

I would also be interested in finding out what others use for a flow sheet for nonbehavioral restraint documentation. If at all possible, could anyone send me a copy of their flow sheet?

Thanks.