Restraint Competency

San Francisco General Hospital & Trauma Center Administrative Policy 18.09 Restraints Application Demonstration Competency Checklist

Introduction: The purpose of the SFGH Administrative Policy 18.09 Restraints and its corresponding application demonstration training is to

ensure the use of restraints maintains a safe environment, prevents injury, and maintains dignity of patients and staff.

Restraint use is not without risks. Restraints have the potential to cause physical and psychological harm, loss of dignity, and even death. Pressure ulcer formation, hypostatic pneumonia, constipation, incontinence, contractures, and neurovascular impairment can result from the enforced immobility that results from using restraints. Altered sensory perception and thought processes may also result. Humiliation, fear, anger, and a decreased sense of self‐esteem may occur.

Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others when all other less restrictive options have failed and must be discontinued at the earliest possible time.

Just as patient behavior is not 100% predictable, no product is 100% foolproof. Patient safety requires regular reassessment and monitoring per facility policy. A product that worked in the past may be inappropriate if the patient’s mental or physical health status changes.

SFGH utilizes the following types of restraints as appropriate to the care setting: o Soft‐tie Limb Restraints o Hand Mitt Restraints o Vest / Torso Restraints o Lock‐Buckle Restraints o Physical Hold (Manual) Restraints

A restraint does not include devices or other methods for the purpose of conducting routine physical examinations, therapeutic

procedures, or tests. Any measure or intervention used that can be intentionally removed by the patient in the same manner as it was applied is not considered a restraint:

o (IV) Arm Boards o Mechanical support o Positioning/Securing device o Age or developmentally appropriate protective interventions o Physical hold for consented medication o Stretcher/gurney/hospital bed side rails. o Prescribed medications not meeting definition of Chemical Restraints o Law enforcement intervention


Participant:

Trainer:

Date:

NOV 2012

SOFT ‐ TIE LIMB RESTRAINTS

APPLICATION DESCRIPTION PASS NOTES

1.

Prepare the limb holder by passing the narrow end through the slit in the wide end. Pull the strap through the slit and feed through the loop attached to the cuff. This will create a loose cuff with the synthetic fur or flannel on the inside.

2. Using the strap from the wide end of the cuff, encircle the cuff and feed the strap from the wide end through the loop in the opposite direction of the strap from the narrow end.

3.

Place the patient’s hand or foot through the cuff, tighten the cuff and secure the hook and loop fastener. There should be enough space for the caregiver to insert one finger between the patient and the limb holder to ensure that the patient’s circulation has not been compromised.

4. Do not tie the straps in a knot. Use the quick release tie technique.

5. For wheelchair use: attach ties to the frame of the wheelchair using quick‐release ties.

6. For bed use: attach ties to the movable portion of the bed frame using quick‐release ties. Do not attach to movable side rails.


Participant:

Trainer:

Date:

NOV 2012

HAND MITT RESTRAINTS


1. Insert the patient’s hand into the mitt, palm down.

2. Wrap the wrist strap around the smallest part of the patient’s wrist, over the top of the wrist, through the plastic ring, and secure it onto itself.

3. Bring the second hook strap over the top of the loop strap to form a “double security” closure.

4. Slide ONE finger (flat) between the device and the inside of the patient’s wrist to ensure proper fit. The strap must be snug, but not compromise circulation.

NOTE

Follow steps 5‐6 for use of optional bed connecting strap (hospital bed use only) to help prevent the patient from removing the device or inflicting self‐injury:

5. Wrap the strap around the patient’s wrist or pass it through the loops on the mitt.

6.

Use Posey Quick‐Release Tie to secure the end of the strap to a movable part of the bed frame. Do not secure to movable side rails. Tie strap at a point midway between the patient’s wrist and elbow, out of the patient’s reach.


Participant:

Trainer:

Date:

NOV 2012

VEST / TORSO RESTRAINTS


1. Place the device on the patient with the opening in the back. Makesure side seams are located under the arms. If they are not, the sizing may be incorrect.

2. Close with the zipper, or hook and loop fasteners.

3. Secure straps to the wheelchair or bed frame, out of the patient’sReach.

4. Slide an open hand (flat) between the device and the patient to ensureproper fit. The device must be snug, but not interfere with breathing.

WARNING

A restraint applied incorrectly or worn backwards may result in serious injury or death from suffocation, chest compression or patient escape.

NEVER criss‐cross straps directly behind the patient. Straps may loosen if the patient rotates.

Make sure straps cannot slide, loosen, or tighten if the patient pulls on them, or if the bed or chair seat position is adjusted.

WHEELCHAIR USE:

a. Position the patient as far back in the seat as possible with the

buttocks against the back of the chair.

b. Bring the straps over the hips at a 45‐degree angle and pass down

between the seat and the wheelchair sides (fig. 1).

c. Criss‐cross the straps, and use quick‐release ties to attach straps to

the opposite side kick spurs, out of the patient’s reach (fig. 2).

d. If the chair has an adjustable seat, secure straps to a movable part

of the chair frame, out of the patient’s reach.

BED USE:

a. Secure straps with quick‐release ties to a movable part of the bed

frame at waist level, out of the patient’s reach. Do not secure straps to movable side rails.


Participant:

Trainer:

Date:

NOV 2012

LOCK‐BUCKLE RESTRAINTS


PLACEMENT:

1. Position the patient on the bed.

2.

Bring the ends of the strap down through the inside of the side rails so they do not interfere when the side rails are raised. Thread the end of the strap over the top, around the frame, and through the lock. Make sure that the straps are attached to a movable part of the bed frame, out of the patient’s reach. Do not attach to movable side rails.

3. Pull the strap snug and close the lock. Check that the lock “clicks” shut. If a lock is not completely closed, it can pop open. Before leaving the patient’s side, test the lock by trying to open it without the key.

APPLICATION: (repeat steps 1.through 3. for each limb)

1.

Wrap the neoprene piece (the blue or red side should be positioned against the skin) around the wrist/ankle. Attach the black hook and loop pieces together, followed by the blue or red hook and loop pieces. The fuzzy piece should be sandwiched between the two pieces of hook (fig. 1). Be sure to overlap at least one inch (3 cm).

2.

Press the hook and loop closure together firmly and make sure it adheres securely. Slide ONE finger (flat) between the cuff and the inside of the patient’s wrist to ensure proper fit. The cuffs must be snug enough to prevent escape, but not interfere with circulation.

3.

Pass the end of the short strap through the lock and adjust it to thedesired length. Check that the lock “clicks” shut. If a lock is not completely closed, it can pop open. Before leaving the patient’s side, test the lock by trying to open it without a key.

UNLOCKING:

NOTE:

Universal Posey Keys MUST be readily available to staff at all times. In an emergency, it is difficult to cut the cuffs with scissors.

1. Insert the Posey Key into the lock and turn counterclockwise. This will prevent jamming (fig. 2).


Participant:

Trainer:

Date:

NOV 2012

PHYSICAL HOLD (MANUAL) RESTRAINTS

APPLICATION DESCRIPTION PASS NOTES WARNING

Physical hold procedures is a restraint process that is initiated when a team of two (2) or more trained health care professionals have decided to respond to a safety issue.

In the event that a staff person finds himself/herself to be the only person responding to an aggravated assault incident, that staff person will need to call for additional help to respond to the situation.

1.

Grasp the aggressor’s arm at two points by their clothing between joints whenever possible, while protecting the aggressor’s breathing and circulation. One point should be in lower limb near wrist or forearm. Grab wrist or wrap pt’s sleeves in staff’s grip. Second contacts should be the upper arm or near shoulder. The upper arm should be secured by staff’s inner arm coming under patient’s arm pit and up. Grabbing staff’s own clothing with inner arm is more secure. Two staff members at least are required to contain upper limbs, more if all four limbs to be secured.

2. Stand slightly behind and to the side of the aggressor with knees bent in a slight crouching position.

3.

Maintain control of the grasped arm at a 45‐degree angle down from the horizon. Hold arm across your chest to decrease movement of arm. Be cautious not to hyper flex the elbow when tightening grip.

4.

Utilize leverage/weight, and avoid contests of strength. Use two hands to secure aggressor’s one arm. Most leverage comes from contact point being closer to staff’s torso than patients. Staff’s combined weight should have a minimum of 200% of the patient’s weight.

© Pro‐ACT, Inc.

Documents

Restraint Competency