Notes

Outline

RESTRAINTS MAUREEN GUZMAN

Introduction HCFA and JCAHO have changed regulations/guidelines for use of restraint and seclusion in healthcare OMH has revised our policy “Patient Restraint and/or Seclusion at Olympic Memorial Hospital” (Admin. 11.10)

Purpose of this presentation… Present OMH’s philosophy regarding use of restraints Define restraint/seclusion Discuss restraint orders Introduce the new procedure for restraints

Overview Patient Safety is the important issue HCFA and JCAHO are concerned that too many patients are being unnecessarily restrained in hospitals Patients are dying while in restraints

Olympic Medical Center Philosophy Patients have the right to be free from restraints of any form that are not medically necessary. Restraints may not be used as a means of coercion, discipline, convenience, or retaliation by staff.

Definitions

Physical 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.

Seclusion The involuntary confinement of a person in a room or an area, from which he or she is physically prevented from leaving.

Drug used as a Restraint 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 treatment.

Restraint Orders Given by a physician or other LIP Based on an appropriate assessment of the patient Time limited Include rationale/reason for restraint No standing or prn orders

Procedure for use of restraint Restraint procedure is guided by one of two standards: Restraint for Acute Medical and Surgical Care Restraint and/or Seclusion for Behavior Management

Restraint for Acute Medical and Surgical Care Limited to situations where there is appropriate clinical justification Time limited MD order < 24 hours If MD unavailable restraint initiated by RN based on appropriate assessment MD notified within 12 hours and order obtained Order renewed at least once/day based on MD in person assessment

Restraint for Acute Medical and Surgical Care Patient monitoring q 2 hours Physical and emotional well-being of patient including nutritional,hydration, elimination needs Patient’s rights, dignity, safety maintained Evaluate less restrictive methods Patient evaluated for removal of restraints Restraint appropriately applied Evaluate circulation/sensation Monitoring and assessment documentation at minimum q 8 hours

Restraint and/or Seclusion for Behavior Management Reserved for occasions when unanticipated, severely aggressive or destructive behavior places the patient and/or others in eminent danger Restraint may be initiated by RN based on appropriate assessment of patient Physician must see patient and evaluate need for Restraint/Seclusion within 1 hour after initiation of restraint

Restraint and/or Seclusion for Behavior Management Orders limited to Adults max 4 hours Ages 9-17 max 2 hours Under 9 years max 1 hour May be renewed to total 8 h adults; 4 h <18y/o MD must perform an in person reevaluation at least q 8 hours for age 18 and older and  q 4 hours for age 17 and younger Nurse will promptly notify patient’s family of initiation of restraint &/or seclusion

Restraint and/or Seclusion for Behavior Management Monitoring q 15 min using paper flow sheet Restraint & Seclusion requires monitoring 1/1 or using both video and audio equipment Debriefing post behavioral restraint episode includes pt and staff (ASAP, within 24h) Clinical leadership is informed when pt restrained > 12 h or 2 or more separate episodes of behavioral restraint within 12 h Hospital must report to HCFA, any death occurring while any patient is restrained

Slide 17