physical restraint
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Introduction
Use of physical devices to accomplish restraint.
Classification
Forms of physical restraint:
- soft, 2-4 point (hands & feet)
- leather 2-4 point (violent patients)
- apply in supine position only
- legs straight, arms at side
- staff monitoring patient must have key to restraints
- 2 point 1 arm & opposite leg
- bed rails
- Geri-chair (table-top chair)
- non-releasing lap belt
- hand mittens
Indications
- the patient or others are in danger
- medical & behavior reasons
- substance use (40%), mental illness (24%), or both (24%) most common reasons for agitation leading to restraint[7]
- other possible interventions have been attempted & failed
- NOT diagnosis or setting driven
Monitor
- patient's right, dignity, safety
- opportnities for restraint removal
- circulation
- range of motion, skin care, hygiene, nutrition, hydration, fecal & urine elimination every 2 hours
Complications
- deconditioning
- depression
- disorientation
- pressure ulcers
- may paradoxically increase risk of falls
- choking in the supine position
- dehydration (patients may refuse fluids)
- restraint harmful, not patient-centered, induces fear & frustration[7]
- downstream consequences, including avoidance of future care[7]
Management
- multidisciplinary intervention can reduce the use of physical restraints in nursing homes[2]
- like other complex problems, use of physical restraint is not attenuated by simple educational mandates & requires multicomponent solutions[4]
- intensive training of staff regarding the reasons for physical restraints, their adverse effects, & alternatives to their use reduces use of physical restraints[3]
- reduction in use of restraints reduces the rate of serious injury.[2][3]
Notes
- 36% of patients had a negative perception, 40% had mixed opinions, & 24% thought restrain necessary or blamed themselves for use
More general terms
References
- ↑ Journal Watch, Mass Med Soc 19(23):186 (Dec) 1999
- ↑ 2.0 2.1 2.2 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 3.0 3.1 3.2 Koczy P, Becker C, Ropp K, et al. Effectiveness of a multifactorial intervention to reduce physical restraints in nursing home residents. J Am Geriatr Soc 2011; 59(2):333-339. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21314651
- ↑ 4.0 4.1 Kopke S et al. Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: A randomized controlled trial. JAMA 2012 May 23/30; 307:2177 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22618925
- ↑ Mohler R, Richter T, Kopke S, Meyer G. Interventions for preventing and reducing the use of physical restraints in long-term geriatric care. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD007546. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21328295
- ↑ Rakhmatullina M, Taub A, Jacob T. Morbidity and mortality associated with the utilization of restraints : a review of literature. Psychiatr Q. 2013 Dec;84(4):499-512. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23649219
- ↑ 7.0 7.1 7.2 7.3 Wong AH et al. Experiences of individuals who were physically restrained in the emergency department. JAMA Netw Open. 2020 Jan 3;3(1):e1919381 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31977058 Free PMC Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2759276
Nussbaum AM, Wynia MK. "When they restrain you they ignore you" - What we should learn from the people we restrain in emergency departments. JAMA Netw Open 2020 Jan 24; 3:e1919582 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31977054 Free full text https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2759272