Restraints: Special Considerations (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 So we've talked a lot about restraints, I want to talk about one more important topic before you leave today.

    00:10 I know there's a lot of considerations, but all of that is important because a patient really can get injured, while in restraint use.

    00:19 So one thing to consider, is death and restraints.

    00:22 Okay, this is a pretty dark topic, but this really can happen and it has occurred while patients are in restraints.

    00:28 We call it a "Never Event", what do I mean by that? Meaning, a death and restraint, should never happen.

    00:35 This is actually called a "Never Event" by the Center for Medicare and Medicaid Services.

    00:42 So, this is an over urgency reporting agency, that, if a death happens, that we must report it to them and they track all of these.

    00:49 As of how it happened, why, what type of restraints, were we giving the appropriate amount of care? So a death while in restraint or seclusion again must be reported immediately to the Center for Medicare and Medicaid Services.

    01:04 Now, this seems a little odd, but this is something that's key to remember as a nurse.

    01:09 If a client death occurs within 24 hours of the patient being in restraint, it still has to be reported to the Center for Medicare and Medicaid Services.

    01:19 Okay, I'll say that again, now, if a patient has passed and it was within 24 hours the patient was either in the restraint or the restraint has been discontinued or stopped, if it's still within 24 hours we still have to report it to CMS.

    01:37 Now, even though the death, maybe we think it was a complication of not having to do with restraints, even if the death was not due to the restraints, we still are required to report it to CMS.

    01:51 Now, some other complications to think about is what we call entrapment.

    01:55 So as you can imagine there's some extra restraint pieces there.

    01:59 There's lots of things that can get hung up, the patient can get hung up within the side rails and restraints this can potentially cause a lot of issues for your patient.

    02:09 Also skin breakdown and why toileting and making sure we do those routine checks and those skin checks for our patients while in restraints.

    02:19 While we're doing those skin checks make sure you're checking those circulation points again.

    02:23 Making sure you're checking the warmth of their skin, their pulse points, also their capillary refill.

    02:29 And you can imagine while in a restraint, unfortunately the patient is not comfortable.

    02:34 They're restrained down and there's not a lot of movement.

    02:37 This can definitely cause some immobility, some contractures and some issues for our patient.

    02:43 Now, before we leave, a few more things to leave you with.

    02:46 If you remember at the beginning of this presentation, try alternatives before considering restraints.

    02:52 There's so many alternatives out there, for example, a sitter or reorientation or distraction.

    02:58 Make sure you try these, because a lot of times, these can help to keep the patient out of restraints.

    03:05 Now, re-evaluate restraints every time, it doesn't mean just because they're in a restraint that they have to stay in it.

    03:12 Our goal is to get the patient out of the restraints as soon as we think it's safe to do so.

    03:19 Make sure you check your order and include this in the plan of care.

    About the Lecture

    The lecture Restraints: Special Considerations (Nursing) by Samantha Rhea, MSN, RN is from the course Restraint Management and Application (Nursing).

    Included Quiz Questions

    1. If a client died while in restraints or seclusion
    2. If a client in restraints died of a complication unrelated to restraint use
    3. If a client died within 24 hours after restraints or seclusion were discontinued
    4. If a client died within 72 hours after restraints or seclusion were discontinued
    1. “Entrapment refers to the client being able to get free from the restraints and leave their bed.”
    2. “Restraints are specially designed to not cut off circulation, so I don’t need to worry about checking my client's circulation when they are in restraints.”
    3. “It is very important to assess a client in restraints for signs of skin breakdown.”
    4. “Keeping a client immobile for a prolonged period can have severe health risks, so it’s important to reassess the need for restraints often.”

    Author of lecture Restraints: Special Considerations (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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