Collaborative Approach to Restraint Use
To ensure patients are cared for in the safest environment, it’s crucial for physicians to follow the protocol for using restraints and to collaborate with other care providers in doing so. A committee formed last fall aims to reduce the usage of restraints, and to support physicians’ role in managing these patient populations.
“Patients generally are safer without restraints,” said Mary Antonelli, RN, MPH, Nursing Quality program coordinator. “There are alternatives that can and should be used in many cases before restraints are used.”
Restraints are a last resort after alternatives are tried and failed. Currently, prescribing medications and having a sitter in the patient’s room are the only alternatives to restraints, but the Restraint Reduction Committee is working to create more alternatives. The committee consists of physicians including Kathleen Finn, MD, and Bernie Vaccaro, MD, nurses and representatives of disciplines across the hospital. This summer, the committee will trial equipment, such as lap belts and low beds, and activities and distractions, such as having family and friends sit with the patient, placing the patient in a visually active area or giving them magazines, to reduce the need for restraints. A pilot will take place on Tower 10CD, 16AB and 14CD.
Physicians’ role in reducing restraint usage is crucial. When a nurse calls a physician to ask about ordering restraints, the physician must see the patient within one hour. Physicians should evaluate the patient face-to-face, document their findings and discuss with the nurse the plan of care and whether restraints are the only solution. This process also should be followed before renewing an order for restraints.
The Restraint Reduction Committee also aims to develop care guidelines for health care practitioners to help them manage different patient populations that might require restraints or alternatives to restraints, such as those suffering from dementia, delirium and alcohol withdrawal. “The goal is to provide more support for physicians and the care team at the bedside,” Antonelli said.
Complete documentation of restraint use is required by JCAHO and to ensure continuity of communication.
View BWH’s restraint policy online: www.bwhpikenotes.org/HospitalwidePoliciesAndManuals/AdministrativePolicyManual/V-15.doc