RESTRAINT APPLICATION

• Used only when other, less restrictive, measures prove ineffective in protecting the patient and others from harm.
• Soft Restraints – limit movement (to prevent the confused, disoriented, or combative patient from injuring himself or others.
• Vest and Belt restraints – permit full movement of arms and legs (to prevent falls from bed or a chair.)
• Limb restraints – allow only slight limb motion (to prevent the patient from removing supportive equipment (e.g. I.V. lines, indwelling catheters, NGTs, etc).
• Mitts – prevent the patient from removing supportive equipment, scratching rashes or sores, and injuring himself or others.
• Body restraints – immobilize al or most of the body (to control the combative or hysterical patient.

When to use Leather Restraints?

ü When soft restraints aren’t sufficient

ü When sedation is dangerous or ineffective

*Duration of Leather restraint use is governed by state law and facility policy

Applied to:

ü All limbs (4-point restraints)

ü One arm and one leg (2-point restraints)

*Depending on the patient’s behavior

NOTE!!!

ü Use restraints cautiously in patients prone to seizures (increase the risk of fracture and trauma)

ü Restraints shouldn’t be applied directly over wounds or I.V. catheters (can cause irritation and restrict blood flow)

ü Use vest restraint cautiously in patients with heart failure or a respiratory disorder (can tighten with movement, further limiting circulation and respiratory function)

Equipments needed:

Preparation

• 1. Make sure the restraints are the correct size and weight as a guide BEFORE entering the patient’s room. (if leather restraints will be used, check if the straps are unlocked and the keys fits the locks.)
  2. Use child restraints for a child who may be too small for standard restraints.

Procedures

1. Obtain a doctors order for the restraint

*Doctors order must be time limited

*Original order may be renewed only for a total of 24 hours.

*After the original order expires, doctor must see and evaluate the patient before a new order can be written.

1. If necessary, enlist the help of several coworkers and organize their effort before entering the patients room, giving each person a specific task; for example, one person explains the procedure to the patient and applies the restraints while the others immobilize the patients arms and legs.

1. Inform the patient of the procedures (tell what you’re going to do, describe the restraints to the patient and assure the patient that they are used to protect him/her from injury , rather than to punish him/her.

RESTRAINT APPLICATION

• Used only when other, less restrictive, measures prove ineffective in protecting the patient and others from harm.
• Soft Restraints – limit movement (to prevent the confused, disoriented, or combative patient from injuring himself or others.
• Vest and Belt restraints – permit full movement of arms and legs (to prevent falls from bed or a chair.)
• Limb restraints – allow only slight limb motion (to prevent the patient from removing supportive equipment (e.g. I.V. lines, indwelling catheters, NGTs, etc).
• Mitts – prevent the patient from removing supportive equipment, scratching rashes or sores, and injuring himself or others.
• Body restraints – immobilize al or most of the body (to control the combative or hysterical patient.

When to use Leather Restraints?

ü When soft restraints aren’t sufficient

ü When sedation is dangerous or ineffective

*Duration of Leather restraint use is governed by state law and facility policy

Applied to:

ü All limbs (4-point restraints)

ü One arm and one leg (2-point restraints)

*Depending on the patient’s behavior

NOTE!!!

ü Use restraints cautiously in patients prone to seizures (increase the risk of fracture and trauma)

ü Restraints shouldn’t be applied directly over wounds or I.V. catheters (can cause irritation and restrict blood flow)

ü Use vest restraint cautiously in patients with heart failure or a respiratory disorder (can tighten with movement, further limiting circulation and respiratory function)

Equipments needed:

Preparation

1. Make sure the restraints are the correct size and weight as a guide BEFORE entering the patient’s room. (if leather restraints will be used, check if the straps are unlocked and the keys fits the locks.)
2. Use child restraints for a child who may be too small for standard restraints.

Procedures

1. Obtain a doctors order for the restraint

*Doctors order must be time limited

*Original order may be renewed only for a total of 24 hours.

*After the original order expires, doctor must see and evaluate the patient before a new order can be written.

1. If necessary, enlist the help of several coworkers and organize their effort before entering the patients room, giving each person a specific task; for example, one person explains the procedure to the patient and applies the restraints while the others immobilize the patients arms and legs.

1. Inform the patient of the procedures (tell what you’re going to do, describe the restraints to the patient and assure the patient that they are used to protect him/her from injury , rather than to punish him/her.

In the United Kingdom, bioengineers at the Strathclyde Institute for Medical Devices, Glasgow, Scotland, have developed a new system that allows doctors and nurses to check the conditions under a dressing without having to remove it. A tiny sensor is attached to the gauze monitors to detect whether the wound is moist—the optimum environment for healing—or too dry or wet to heal properly. About half the size of a first class stamp, the sensor is attached via a sterile pad to the dressing itself, thus avoiding pain to the patient. It is connected to wires that can be plugged in to the monitor to allow doctors or nurses to take a reading.

The system is currently under clinical trial on patients with chronic leg ulcers with NHS Greater Glasgow and Clyde. It is anticipated it could be used for any kind of chronic or acute wound, including burns, chronic surgical wounds, and pressure ulcers.

In a recent study published in the Journal of Gerontology: Medical Science, researchers suggest that obesity reduces the risk of developing pressure ulcers in hospitalized older adults. A total of 3214 patients admitted to 2 Philadelphia, PA, hospitals between 1998 and 2001 were assessed for risk factors for pressure ulcers. The goal of the investigation was to evaluate the chances of developing a pressure ulcer in both underweight and obese patients, relative to optimal weight patients. Patients enrolled in the study who were underweight demonstrated greater odds of developing a pressure ulcer (adjusted odds ratio [OR] = 1.8; 95% confidence interval [CI], 1.2-2.6). Study participants who were obese had reduced odds (adjusted OR = 0.7; 95% CI, 0.4-1.0), and those with severe obesity had the lowest odds of developing a pressure ulcer (adjusted OR = 0.1; 95% CI, 0.01-0.6). The investigators concluded that extra body fat lowers the risk of pressure ulcers in hospitalized older adults.

Source: Compher C, Kinosian BP, Ratcliffe SJ, Baumgarten M. Obesity Reduces the Risk of Pressure Ulcers in Elderly Hospitalized Patients. J Gerontol A Biol Sci Med Sci 2007;62(11):1310-2.

Monitor Helps Measure Bandage Pressure

Ulsys, Halifax, UK, launched the Vowden Trainer, a cutting-edge pressure monitor designed to increase the accuracy of leg ulcer treatment, at Medica 2007, which was held recently in Germany. The Vowden Trainer works by accurately measuring the application of pressure under a bandage applied over a leg ulcer, indicating exactly how much pressure the bandage is generating in order to help health care professionals apply the correct pressure without having to estimate. This eliminates inconsistent pressure application, allows for greater accuracy in treatment, and saves working time.

Hospitals across the country are exploring the use of preoperative antiseptic skin cleansing or skin prepping to prevent or reduce the incidence of surgical site infections (SSIs). According to the Centers for Disease Control and Prevention, SSIs are the leading hospital-acquired infection (38%) in surgical patients and the third most common in hospitalized patients. At Prince William Hospital in Manassas, VA, clinicians saw reduced incidence of SSIs, an estimated cost savings of more than $100,000, and a 75% decrease in SSI-related readmissions after 6 months of implementing a preoperative skin cleansing protocol. Lakeview Hospital in Stillwater, MN, improved its preoperative skin preparation protocol by implementing a new product, leading to a 50% reduction in SSI rates in patients undergoing joint procedures. And VA Central Iowa Health Care System in Des Moines, Iowa, saw improvement after implementing a new preoperative skin preparation product, educating patients about appropriate skin antisepsis, and increasing compliance with preoperative skin antisepsis.

Novation, the leading health care contracting services company, offers its Wound Drainage Program, which can help hospitals convert wound drainage products to reduce costs, meet clinical acceptability, and consolidate items. Novation aids hospitals in implementing a strategic process to provide clinicians with feedback opportunities before a conversion decision is made, ensuring that items are accurately identified and cross-referenced, establishing a product evaluation process, and collecting feedback on the clinical acceptability of the new products and reduced costs.

Swiss-American Products, Inc, Dallas TX, introduces the Complete Program as part of its relationship with Tempur-Pedic Medical. The Complete Program gives support to qualified direct medical suppliers of Tempur-Pedic Medical products and is designed to entice customers to retail stores and increase institutional sales. The program offers special promotions and pricing to members and is committed to helping members fund advertising of Tempur-Pedic Medical products, including co-op opportunities, ad creation, available ads for newspapers, and direct mail components such as mailing lists and letter shop services. It also offers local and regional sales leads from Swiss-American’s clinical customers, access to a full library of studies, and training in a variety of areas, including sales tactics and product features.