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physical restraint

Use of physical devices to accomplish restraint. Classification: Forms of physical restraint: 1) soft, 2-4 point (hands & feet) 2) leather 2-4 point (violent patients) a) apply in supine position only b) legs straight, arms at side c) staff monitoring patient must have key to restraints d) 2 point 1 arm & opposite leg 3) bed rails 4) Geri-chair (table-top chair) 5) non-releasing lap belt 6) hand mittens Indications: 1) the patient or others are in danger 2) medical & behavior reasons 3) substance use (40%), mental illness (24%), or both (24%) most common reasons for agitation leading to restraint [7] 4) other possible interventions have been attempted & failed 5) NOT diagnosis or setting driven Complications: 1) deconditioning 2) depression 3) disorientation 4) pressure ulcers 5) may paradoxically increase risk of falls 6) choking in the supine position 7) dehydration (patients may refuse fluids) 8) restraint harmful, not patient-centered, induces fear & frustration [7] 9) downstream consequences, including avoidance of future care [7] Monitor: 1) patient's right, dignity, safety 2) opportnities for restraint removal 3) circulation 4) range of motion, skin care, hygiene, nutrition, hydration, fecal & urine elimination every 2 hours Management: - multidisciplinary intervention can reduce the use of physical restraints in nursing homes [2] - like other complex problems, use of physical restraint is not attenuated by simple educational mandates & requires multicomponent solutions [4] - intensive training of staff regarding the reasons for physical restraints, their adverse effects, & alternatives to their use reduces use of physical restraints [3] - reduction in use of restraints reduces the rate of serious injury. [2,3] Notes: - 36% of patients had a negative perception, 40% had mixed opinions, & 24% thought restrain necessary or blamed themselves for use

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References

  1. Journal Watch, Mass Med Soc 19(23):186 (Dec) 1999
  2. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  3. Koczy P, Becker C, Ropp K, et al. Effectiveness of a multifactorial intervention to reduce physical restraints in nursing home residents. J Am Geriatr Soc 2011; 59(2):333-339. PMID: 21314651
  4. Kopke S et al. Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: A randomized controlled trial. JAMA 2012 May 23/30; 307:2177 PMID: 22618925
  5. Mohler R, Richter T, Kopke S, Meyer G. Interventions for preventing and reducing the use of physical restraints in long-term geriatric care. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD007546. Review. PMID: 21328295
  6. Rakhmatullina M, Taub A, Jacob T. Morbidity and mortality associated with the utilization of restraints : a review of literature. Psychiatr Q. 2013 Dec;84(4):499-512. Review. PMID: 23649219
  7. Wong AH et al. Experiences of individuals who were physically restrained in the emergency department. JAMA Netw Open. 2020 Jan 3;3(1):e1919381 PMID: 31977058 Free PMC Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2759276 - Nussbaum AM, Wynia MK. "When they restrain you they ignore you" - What we should learn from the people we restrain in emergency departments. JAMA Netw Open 2020 Jan 24; 3:e1919582 PMID: 31977054 Free full text https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2759272