Collaborative Approach to Restraint Use
To ensure patients are cared for in the safest environment, it’s vital for nurses to collaborate with other care providers to follow the standards of care for the use of restraint. BWH’s philosophy is that restraints are used only as the last resort after alternatives are tried and unsuccessful.
“Patients generally are safer without restraints,” said Mary Antonelli, RN, MPH, Nursing Quality Program coordinator. “Often, restraints are applied because nurses think a patient will fall or hurt him or herself, but there are alternatives that can be safer for the patient.”
Currently, prescribing medications and having a sitter in the patient’s room are the alternatives commonly used. In a quest to identify other alternatives, a restraint reduction committee of nurses, physicians and representatives from across the hospital was formed last fall. One of the committee’s goals is to make more alternatives available for use at the bedside, and it will trial a Restraint Reduction Program this summer on Tower 10CD, 16AB and 14CD. The trial will focus on the use of new products, such as lap belts, gliders, and low beds, diversion activities to engage patients to channel their energies differently, and a focus on better communication among the clinical team.
“It’s about putting a team around the patient to give them the best care and keep them as safe as possible,” Antonelli said of the committee’s mission.
Nurses play a key role in initiating restraint use, but collaboration with physicians, pharmacists, psychiatrists, physical therapists and the patient’s family is necessary to achieve the best outcome for the patient.
Collaboration with the physician team is key. Physicians must see a patient within one hour of a nurse notifying the physician with a request for an order to initiate a restraint. Physicians must evaluate the patient face-to-face, document their findings and discuss the plan of care and use of restraints with the care providers involved. This process also should be followed before renewing an order for a restraint.
Complete documentation of restraints is required for continuity of communication. “When you don’t document what works and what doesn’t work, you are not supporting the success of your nursing colleagues who may care for your patient on the next shift, which eventually affects the best outcome for your patient,” Antonelli said.
Documentation and reduction of restraint usage is a JCAHO requirement. However, “BWH is committed to doing so because it’s the right thing for our patients,” Antonelli said.
View BWH’s policy on restraints online:
www.bwhpikenotes.org/HospitalwidePoliciesAndManuals/AdministrativePolicyManual/V-15.doc