Why use restraints if they are not needed?

Simple steps to avoid restraint use

Nurses often use minimally restrictive measures to keep patients from unknowingly hurting themselves or staff members. For example, asking patients if they need to go to the bathroom prevents them from trying to get out of bed by themselves and falling on the way. When these and other less-restrictive measures were introduced as restraint alternatives to the staff at Methodist Hospitals of Memphis (TN), they said, "We can do that."

Cynthia Caudle, BSN, nursing quality coordinator, reports that the staff was receptive to trying less-restrictive measures. Here is a sample of what they learned during their inservice training, which was a part of the hospital’s new restraint policy:

• Staff should make periodic rounds to see if patients who need help going to the bathroom want to go. This also provides an opportunity to remind the patient to ask for help when needed.

• Underwear briefs can be put on to discourage patients from getting at their Foley catheters and removing or dislodging them.

• Physicians can order (and nurses can lobby for) percutaneous enteral gastrostomy (PEG) tubes to replace nasogastric (NG) feeding tubes. The PEG lines, which go through the skin into the stomach, are less likely to be removed than NG tubes, which go through the nasal passage.

• Intravenous lines can be put through a patient’s sleeve and hidden, which makes it more difficult for the patient to touch or remove. "The less we can get our patients to see, the less they are likely to play with it," Caudle says.

The hospital also purchased mittens and thumb splints to reduce a patient’s pinching ability. This also prevents the removal of medical devices and the patient’s ability to pick at things without the need for more restrictive restraints.