Date post: | 14-Dec-2015 |
Category: |
Documents |
Upload: | virginia-well |
View: | 241 times |
Download: | 5 times |
What are Restraints? Restraints are
physical, chemical or environmental measures used to control the physical or behavioural activity of a person or a portion of his/her body.
LawsPolicies of the Ministry of Health and Long-Term
Care that are binding on long-term-care facilitiesStatutes and regulations of Ontario that govern
the use of restraints in facilities (the Charitable Institutions Act, the Nursing Home Act, the Homes for the Aged and Rest Homes Act)
The common law, which includes among various civil wrongs the torts of battery, assault and false imprisonment
The Criminal Code of Canada, which includes criminal offences.
The Canadian Constitution, which includes the Canadian Charter of Rights and Freedoms.
Risks of Restraints Falls Strangulation Loss of Muscle tone Pressure sores Decreased mobility Agitation Reduced bone mass Stiffness Frustration Loss of Dignity Incontinence Constipation
Who? What? Why? How? When?
Least restraint means all possible alternative interventions are exhausted before deciding to use a restraint.
This requires assessment and analysis of what is causing the behaviour. All behaviour has meaning. When the reason for the behaviour is identified, interventions can be planned to resolve whatever difficulty the resident is having that contributes to the consideration of restraint use.
Kensington Gardens Policy
Restraint Assessment Form must be completed prior to initial application of the restraint.
Assessment Tools
Behavioural Map Aggressive Behaviour
Risk Assessment Cohen-Mansfield
Agitation Inventory Continence Assessment TENA incontinence
product evaluation
Environmental Improved or altered lighting Path cleared in resident's
room/on unit Cloth barrier across
doorway Comfortable room
temperature Privacy and dignity Environment personalized Wanderguard applied Moved to secure unit Night light
Safety
Positioning of pillows Bed height lowered Call bell within easy
reach Bed, Chair or Seatbelt
Alarm Side rails Floor pad beside bed
Toileting and Continence
o Individualized toileting routine
o Product change o Identify bathroom using
signs/symbols o Commode at bedside o Urinal at bedside
Direct Care
One to one supervision/support Medical conditions, i.e. infections Individualized daily routine Move resident closer to RHA
Infomation Centre Facilitate rest periods Limit time spent in bed
Direct Care Continued Apply glasses and/or
hearing aides Use ambulatory aides as
per Care Plan Evaluate medical
interventions i.e. catheter, feeding tube
Provide cues during care/activities
Physiological Interventions
Treatment of the underlying pathology, i.e. medication ordered Pain management Medication review
Psychological• Companionship • Active listening • Increase family/friends visiting • Consistent staffing • Encourage staff one to one activities • Familiarization with the environment • Behaviour management intervention • Alter sensory stimulation • Remove to a quiet area • Relaxation techniques
Life Enhancement & Programs
Teach safe transfer techniques to resident/family/responsible party
Walking and exercise programs Incorporate exercise into daily
plan of care Meaningful individual and/or
group activities Music therapy PT/OT consult
Nutritional Care
Provide adequate fluid/nutritional intake Adapt provision of nutrition to resident's condition, i.e. finger food, frequent small meals, etc. Dietitian Consult
Referrals
Attending Physician Social Worker Psycho-Geriatric
Team Gerontologist External Therapeutic
Assessment Program i.e. Toronto Rehab
Positioning in a Wheelchair
Hips Level and positioned at the back of the seat
Upper LegsSupported on the cushion to three (3) inches
behind the knee Feet
Resting on the footrests Back
Against the back of the cushion
Positioning in a Wheelchair Headrest
Must be on wheelchair and positioned when chair is tilted
Use of tiltChange tilt position many times
throughout the day Padded Leg Slings
Loose to allow legs to rest back when in tilt
Things that Interfere with Good Positioning
Cushion Check- air amount, gel quality, wrong way, upside down, pommel
Medical- hip flexion restriction, back pain back kyphosis, scoliosis
Pads and transfer slings on top of cushion
Improper Positioning
Falls to the side or forward Slides out of the wheelchair Redness on pressure areas Discomfort Unable to self propel with hands or
feet Unable to engage in functional
activity
Seating Cushion Materials
Foams- Pommel at the front of the cushion
Fluid Gels- Must be kneaded properly after each use
Roho Cushion- Ensure right amount of air
Roho Cushion Correct amount: the
cushion looks ¾ full When pressure is
placed on the cushion, then released, the cushion regains its shape
Too Much Air: All cells are visible, the cushion is hard, unstable and looks too large for the wheelchair
Consent The decision to
apply a restraint involves the resident and/or his family/substitute decision-maker.
Documentation shows thorough assessment of the need for a restraint, including ALL alternate measures attempted
Doctor’s Order Restraint is
applied on written order (or a telephone order which is cosigned) of a Physician who has attended the resident and approved the type of restraint.
Approved Restraints Wheelchair tray Rear facing seatbelts Lap restraint Mitt restraint Self limiting seat belt
(resident cannot undo without assistance)
How Often do I check?
The resident is checked at a minimum of hourly and repositioned at a minimum of every two hours while restrained.
Proper Application of Seatbelts ONLY FASTEN THE
SEAT BELT IF & WHEN REQUIRED
MAKE SURE THE SEAT BELT IS IN GOOD CONDITION
Compare to a Car Seatbelt CHECK THAT THE
SEAT BELT IS TIGHTENED APPROPRIATELY
Place one flat hand between belt and resident
Too Loose is Dangerous
Position at the hips not the abdomen
NO Twisting Ensure the belt is not
twisted Do not tie belt
around arm of chair If seatbelt is too long
inform Shopper’s Home Health
Reassessment The need for continuing use
of the restraint is reassessed within 12 hours and the Restraint Monitoring record signed at the bottom by the Registered staff to indicate the continued need past twelve hours
Registered staff are also required to reassess restraint quarterly