Patients at risk: Impaired mobility

due to injury, disease

Receiving medications that alter mental status

Be disoriented due to change in environment or medical disorder

Impaired hearing/vision

Falls may occur due to

Misjudging distance Feeling weak/dizzy Position changes too

fast Hazards while

walking Walking in poor lit

area

Leave bed In lowest horizontal position Keep brakes locked Keep side rails elevated Check for protruding objects Do not clutter/block open ears with supplies Wipe up skills immediately Encourage patients to use rails along corridor

when walking Monitor patients for signs of weakness, fatigue,

dizziness and loss of balance Monitor patient for safety if they are

independent ◦ Can they: propel their wheelchair, transfer OOB,

ambulate

Research show restraints do NOT necessarily reduce falls or prevent injuries – it may actually cause serious injuries and death

Chemical Physical

Medications that affect the patient’s mood and behavior

Any technique or device that is attached or next to the patient’s body that the patient cannot easily remove and that restricts freedom of movement and normal access to the body

OBRA (1987) states when and how chemical and physical restraints may be used in a long-term care facility. Physical restraints are to be used ONLY when the safety of the patient or other persons are at risk.

Documentation of all patient behavior that indicates the need for restraints

Documents all actions taken as alternative prior to restraints

Consults the patient/family when alternatives are not successful

If cause of patient’s problem can be identified and corrected, the need for restraints can be eliminated

If restraints are required, the least restrictive restraint is required to be selected

Must have MD order

Hand mitt

Vest restraint

Limb restraint

Wheelchair belt

Geriatric chairs

Jacket restraint

Alternative for confused patients who try to climb over side rails

NOT used for mentally alert patients

Netting surrounds bed to keep patient safe, but not considered a barrier to movement

Devices that empower patients to assist themselves to function◦ Wheelchair to sit upright◦ Postural supports: devices used

to assist w/ posture Lap tray Lap buddy

◦ Side rails are, by definition, restraints Make sure space between rail and

bed is small

Keep bed in lowest position

Keep bed wheels locked

Place mat on floor if patient tries to get out of bed

Meet patient needs promptly: water, hunger, pain, etc.

Use side rail cushions Pressure-sensitive

chairs or chair alarms

Care for patient’s personal needs promptly

Know wh/ patients are at risk

Observe patient’s walk Report mental changes Maintain safe

environment Provide comfortable

chairs Use security devices

Obtain MD order Try least restrictive

device first Use correct type/size of

restraint Apply restraints

according to instructions Avoid restraint if frayed,

torn, or missing parts Apply restraint over

clothing, not skin

Explain procedure to patient

Check fit after applying restraint

Tie restraints with slip knot

Make sure call light is accessible

Release restraint q2h for 10 min

Maintain patient body alignment

Avoid restraints in moving vehicles and toilets

Accidental poisoning Thermal injuries

Make sure food in bedside table will not spoil

Keep chemicals and cleaning solutions in locked cupboards

Store personal food items in refrigerator w/ label and date expired

Follow procedures accurately

Check water temperatures before bathtub or shower

Check food temps before feeding patient

Store smoking materials in safe, locked area

Skin injuries Choking

Store knives, scissors, razors and tools in locked area

Store syringes in locked area

Clean up broken glass immediately

Be aware of patients that have swallowing difficulty◦ Cut food into small pieces◦ Feed slowly◦ Offer liquids between bites◦ Place food in unaffected

side of the mouth (if stroke)◦ Use thickeners for liquids

Keep patient in upright position 30 min. after meals

Give oral care at the end of the meal

Know choking procedure

Body alignment:◦ Maintaining a person in a position in which the

body can properly function

Occurs when body alignment is not maintained or when the patient’s position is not changed often enough◦ Pressure ulcer (bedsores) result when unrelieved

pressure on a bony prominence interferes with blood flow to the area

◦ Contractures occurs when a joint is allowed to remain in the same position for too long

Used to maintain body alignment and position◦ Pillows◦ Splints (orthotic devices)

◦ Special boots/shoes

◦ Bed cradles

◦ footboards

Prone – on the abdomen Supine – on the back Lateral – on either side Sims’s – left lateral (slight variation) Fowlers – upright; variation include high

fowlers (90°) and semi-fowlers (45°)

Major responsibility of the CNA Use turning sheet/draw sheet to assist in

lifting and make moving easier◦ Sheet must extend from above the shoulders to

below the hip Remember body mechanics rules