Restraint and Seclusion



Restraint and Seclusion







CLINICAL GUIDELINES



  • Restraint is defined as any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move the arms, legs, body, or head freely. A restraint may also be a drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition (The Joint Commission, 2009) (Table 96-1).


  • Restraints are used in two distinct situations, the definition of restraint is determined by local, state, and national agencies which have instituted special programs to safeguard patients, families, visitors, and healthcare providers (Figure 96-1).



    • Nonviolent/non-self-destructive restraints: used to protect therapeutic interventions such as IV catheters, enteral feeding tubes, endotracheal tubes, surgical sites, and other tubes from being dislodged by the patient.


    • Violent/self-destructive restraints and/or seclusion: used to protect the healthcare worker, families, and patients from violent or self-harm behaviors. Seclusion is only used as a violent/self-destructive restraint.


  • Chemical restraints include, but are not limited to, psychotropic medications, tranquilizers, and hypnotics that are not part of the prescribed medical treatment. These guidelines do not address policies and procedures for administration of chemical restraints.


  • The child has the right to be free from restraint/seclusion of any form that is not necessary for effective medical treatment or is used as a means of coercion, discipline, convenience, or retaliation by staff; restraint is a safety measure of the last resort. In selection of restraint/seclusion, the least invasive option that is effective should be used.



caREminder

The healthcare provider must determine if a device will be considered a restraint. For example if a child is getting out of bed and the nurse puts all four rails up to keep him/her in bed, it is considered a restraint. However, if the nurse puts all but one rail up, then the side rails are not a restraint. If the child is actively having seizure, the side rails are up and padded, and the nurse documents that the padded side rails are to keep the patient safe during the seizure, then the side rails are not considered a restraint. However, if the patient is seizure free and the nurse continues to have the side rails padded and up, the side rails are considered a restraint.


GUIDELINES FOR PHYSICAL RESTRAINT, POSITIONING OR SECURING DEVICES USED TO MAINTAIN POSITION, LIMIT MOTILITY OR TEMPORARILY IMMOBILIZE DURING PROCEDURES



  • Restraint standards do not apply to limitation of mobility related to medical, diagnostic, or surgical procedures and related postprocedure care practices (e.g., positioning during procedures, intravenous [IV] armboards, protection of surgical and treatment sites) and adaptive support based on the patient’s need (e.g., orthopedic appliances, tabletop chairs) (Table 96-1 and Figure 96-2).









TABLE 96-1 Restrain and Seclusion Overview







































Violent/Self-destructive Restraints or Seclusion


Types of Restraint

Examples of When Used

Time Limits for Restraint Order

Licensed Independent Practitioner Evaluation


Locking restraints or soft limb restraints


Seclusion

Child is combative, violent, suicidal, imminent risk of harming self or others

PRN orders are prohibited


Not to exceed




  • 4 hours, 18 years of age and older



  • 2 hours, 9-17 years of age



  • 1 hour, younger than 9 years


May be renewed up to a maximum of 24 hours

In person, within 1 hour of restraint initiation regardless of whether or not the restraint or seclusion was discontinued prior to the evaluation.


Must occur at least once during a 24 hours period if the patient remains in restrain or seclusion.


Positioning or Securing Devices Used to Maintain Position, Limit Motility or Temporarily Immobilize during Procedures


Types of Device

Examples of When Used

Time Limits for Restraint Order

Licensed Independent Practitioner Evaluation


Mummy wrap


Orthopedic appliances


Tabletop chairs


Helmets


Postural support devices


Stretchers with all side rails up

Nursing procedures (e.g., venipuncture, wound care, tracheostomy care, urinary catheterization)


Medical procedures (e.g., bone marrow biopsy, lumbar puncture, suturing of wounds)


Diagnostic procedures (e.g., x-ray, ultrasound, imaging procedures)

None

None


Nonviolent/Non-self-destructive Restraints


Types of Device

Examples of When Used

Time Limits for Restraint Order

Licensed Independent Practitioner Evaluation


Soft limb restraints


Locking restraints


Side Rails (when all available side rails are up)


Elbow immobilizers (when both arms are immobilized)

To protect the dislodgement of endotracheal tubes, IVs, Foley catheters, dressings, surgical drains, gastric tubes, any medical intervention

PRN orders are prohibited


Every 24 hours or every calendar day

None



GUIDELINES FOR VIOLENT/SELF-DESTRUCTIVE RESTRAINT AND/OR SECLUSION USE

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Jul 9, 2020 | Posted by in NURSING | Comments Off on Restraint and Seclusion

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