Monitor, Document Use of Restraints
It’s crucial for the safety of patients in restraints that nurses follow the hospital’s standard of care and complete documentation. BWH’s recent Joint Commission survey showed that nurses need to make immediate improvements in consistently documenting the reassessment of patients in restraints.
“An average of 15 patients are restrained at the hospital on any given day,” said Diane Lancaster, PhD, RN, director of Quality Measurement and Improvement for Nursing. “It’s not high volume, but it is high risk. For that reason, we need to make sure we follow our restraint and documentation policies.”
When caring for a patient with behavioral problems, nurses should evaluate and assess the safety risks of the patient’s behavior and work with the team on the unit to figure out alternative methods to restraints. “There are a number of measures nurses can take to manage a patient’s behavior without using restraints,” said Mary Antonelli, MPH, RN, Nursing’s program manager for Quality.
For example, sometimes patients are restless because they are uncomfortable in bed. “Getting them into a chair or walking them around the unit could solve the problem,” Antonelli said. “Involving PCAs and family in this effort goes a long way.”
The restraint taskforce has reviewed many new products, such as hand mitts to help prevent patients from pulling at IVs and sleeves that go over the arms to disguise dressings. Chair alarms notify nurses when a patient is getting out of a chair. A poster depicting the available products and order information is available from Antonelli.
Last year, three med/surg units piloted safety carts stocked with diversionary activities, such as puzzles, games and other items to use with patients to help manage their behaviors. “Nurses found these carts very effective, and we’re hoping to get them on several additional units later this spring,” Antonelli said.
If alternative methods fail and a patient is restrained, nurses must:
• Document that they tried alternative measures before restraining the patient
• Reassess the patient every two hours when restrained
• Complete all sections of the restraint documentation form
• Document communication with the family regarding application of restraints (because restraints are a change in the level of care)
• Document the reason for release from restraints
“A focused open record review of the care of the restrained patient will begin in March to ensure that the required documentation is completed and provide feedback to the nurse on what was done well and what could be improved in relation to care of the restrained patient,” Lancaster said.
Nurses can find the standards of care, as well as a list of alternative methods to restraint, in each patient’s bedside book. The complete restraint policy is available in the Nursing Clinical Practice Manual.