Try these alternatives to using restraints
Try these alternatives to using restraints
Before you restrain a patient, do you always try alternatives? If not, you are not in compliance with new standards from the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations.
Alternatives to restraint must be attempted and documented, stresses Kathleen Catalano, RN, JD, senior consultant to the Greeley Co., a health care professional consulting firm in Marblehead, MA, specializing in regulatory compliance. These include reading to the patient, playing cards, playing music, and walking the patient, she says.
Here are ways to comply with the standards regarding alternatives to restraint:
• Document all attempts.
Your assessment sheet should include space to indicate why less restrictive means were not effective, says Carrie McCoy, PhD, MSPH, RN, CEN, associate professor of nursing at Northern Kentucky University in Highland Heights, KY. "For example, the nurse may document this as unable to meet verbal limits’ or actively suicidal due to drug overdose,’" she advises.
• Be objective when documenting.
In your narrative, be objective and state the facts of what occurred, says McCoy. "For example, the patient became violent. Such-and-such alternatives methods were attempted. At that point, restraints were applied as an emergency measure,’" she suggests.
• Contact family members.
Patients might become calm if a certain individual is in attendance with them, such as a friend or relative, says Ann Kobs, president and CEO of Type 1 Solutions, a Cape Coral, FL-based compliance consulting firm specializing in preparation for accreditation surveys.
If the patient wants someone there, the effort to contact that person must be made and documented, says Catalano. "If several options are given, call several people until you find one of them at home," she recommends. "Document all attempts."
• Use alarms.
Bed alarms might be an effective alternative to restraint, says Kobs. "If the patient gets up, the alarm goes off to alert staff," she explains.
• Involve pastoral care.
Praying with patients can be soothing to some individuals, Kobs suggests. Involve the pastoral care staff at your facility, or ask patients if they have a minister, priest, or rabbi that they’d like to speak with.
• Use a sitter.
Use of sitters at the bedside within a couple of feet of the patient can be effective, says Deborah E. Blazys, RN, BSN, ED nurse at St. Mary’s Hospital in Waterbury, CT. "However, you must provide sitter training and be clear about the sitter’s responsibility," she cautions. The sitter does not hold any personal conversation with the patient or provide care; the he or she only observes behavior and relays any inquiries to another nurse, Blazys explains.
Sitters document every 15 minutes
The ED has a special observation flow sheet for sitters, with documentation done every 15 minutes. The sitter documents whether the patient is sleeping, eating, or going to the bathroom, and the ED nurse documents that sitter is present, the patient’s vital signs, visits, and consults, says Blazys. (See special observation flow sheet, below.)
The form is a timed sheet with headings for time, initials, and observations. There are three columns totaling eight hours worth of time, says Blazys. "Whatever time the sitter begins is the time slot that she/he begins recording in."
There is a place at the top of the form for the patient’s name, address, demographics, and stamped information.
"If the patient becomes a danger to self or others, we try alternative interventions. The last resort is physical restraint and keeping the sitter in place," Blazys says. When the patient calms, the restraints are removed as soon as possible, and the sitter remains in the room, she explains.
If the patient has requests, they are directed to the nurse by the sitter, says Blazys. "However, if the patients request bathroom privileges or to walk a bit, the sitter accompanies them. Patients are never left alone while on sitter watch."
If the sitter is watching two patients, the sitter notifies the nurse that one patient needs to use the bathroom, and a second person sits with the patient while the sitter takes the second patient to the bathroom, she explains.
Keep their hands busy
• Give patients something to hold.
Sometimes if patients are elderly, giving them a plush, stuffed animal or a baby doll quiets them, says Kobs. "It may remind them of a baby, and they will cuddle it," she explains.
Giving them towels to fold and unfold to keep their hands busy is also effective, Kobs notes. "If a patient has tubes, give them some tubing to play with so they leave the other tubes alone," she suggests.
Sources
For more information on alternatives to restraint, contact:
• Deborah E. Blazys, RN, BSN, Emergency Department, 56 Franklin St., St. Mary’s Hospital, Waterbury, CT 06706. Telephone: (203) 574-6004. E-mail: [email protected].
• Kathleen Catalano, RN, JD, The Greeley Co., 200 Hoods Lane, Marblehead, MA 01945. Telephone: (781) 639-8030. Fax: (781) 639-0085. E-mail: [email protected].
• Ann Kobs, President/CEO, Type 1 Solutions, 166 S.E. 18th Terrace, Suite A, Cape Coral, FL 33990. Telephone: 87-SENTINIL or (941) 574-8318. Fax: (941) 574-8814. E-mail: [email protected].
• Carrie McCoy, PhD, MSPH, RN, CEN, Associate Professor of Nursing, Department of Nursing, Northern Kentucky University, Highland Heights, KY 41099. Telephone: (859) 572-6541. Fax: (859) 572-6098. E-mail: [email protected].
The complete restraint and seclusion standards are available on the Joint Commission’s Web site www.jcaho.org. Search for "restraint and seclusion standards for behavioral health" or use this address: www.jcaho.org/standard/restraint/restraint_stds.html. The manuals that include the standards can be purchased by calling the Joint Commission’s Customer Service Center at (630) 792-5800, between 8 a.m. and 5 p.m. CST on weekdays.
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