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    Understanding Restraint Use

    Using restraints
    Mills-Peninsula is dedicated to maintaining an environment that respects individual rights and dignity.

    We believe that the best care allows free movement. However, sometimes it is necessary to restrain patients/residents for their own safety or the safety of others.

    Our first choice when dealing with a patient or resident who is at risk of harming himself or others is alternative methods, some of which are listed here.

    However, we will use restraints if all other alternatives are not effective. We will continue to restrain only for as long as necessary and only under the doctor's direction.

    What are restraints?

    Restraints are anything that restricts a patient's or resident's free movement. The most common are:

    • Soft bands used to secure a patient's or resident's wrists or ankles
    • Roll belt - secures the midsection
    Other restraints include:
    • Mittens to secure hands
    • Vest restraints, which help immobilize a patient's or resident's upper body
    • Swedish belt - secures patient/resident in wheelchair
    • Geri chair - reclining chair with a locking tray in front
    • Leather bands - have key locks
    • Chemical restraints (medications) - used to control behavior or restrict patient/resident's freedom of movement.

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    When are restraints used?

    Restraints are used only for the safety of the patient/resident or others.

    For example, to:

    • Prevent harm to self and others in situations, such as attempts to get out of bed or a chair unassisted although instructed to ask for assistance, or attempts to remove medically necessary intravenous lines or medical tubes.
    • Promote personal safety of the patient/resident when there is evidence of restlessness, poor judgment, combativeness, agitation, disorientation, unsteady gait or movements.
    Alternatives are our first choice. First, we try to calm the patient/resident in ways that don't restrict freedom of movement, such as:
    • Family member stays
    • Reorienting the patient's or resident's sense of time, place or situation
    • Repositioning
    • Walking
    • Pain relief procedures
    • Food or beverage
    • Relaxation techniques
    • Observation
    • Back rub
    • Toileting
    • Bed alert
    • Enclosure Bed
    • Creating a calm, reassuring environment
    Despite our best efforts, these methods may not always be effective for every patient or resident.

    Frequent assessments
    Restraint orders are reviewed by a doctor at appropriate intervals.
    Each patient/resident is assessed individually and restraints are removed as soon as the staff determines there is no safety risk.

    Patients/residents are reassessed frequently by both the doctor and nurse to decide if restraints are still necessary. They also are checked often for any reactions to the restraints, and assisted with meals, toileting and position changes.

    You will be informed
    We encourage families and patients/residents to be involved as much as possible. If restraining a patient/resident is necessary, an immediate family member will be notified.

    It is helpful to have a “contact” in the family to call who can help reduce the patient’s or resident's confusion and anxiety and participate in ongoing discussions regarding the continuing need for restraints.

    If no family member is available immediately, the doctor and nursing staff use their best judgment about whether the restraint is necessary.

    Treatment continues
    All staff members have been trained in using and managing restraints. Treatment will not be interrupted, although the patient/resident may require close observation. Further testing or discussion with the doctor may be required to determine the root cause of behavior or mental changes.
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    How you can help

    The best way to help a patient/resident avoid dangerous agitation is to surround him or her with familiar loved ones. We encourage families to visit as often as possible. Favorite diversions such as music or hobbies may help the patient/resident feel calm.

    If you have difficulty arranging regular visits, talk to the doctor or nurse about private duty sitters. A list of private-pay agencies can be provided. Extended visiting opportunities and sleeper chairs are available for family members to stay overnight.

    You may want to schedule visits during the more stressful times of the patient’s or resident’s day, such as meal or bathing times, treatment or therapy sessions, to provide a friendly face at regular intervals and moral support.

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    Questions?

    Discuss any questions or concerns with the nurse who is caring for the patient or resident, or with the doctor. You also may contact our Patient Relations coordinator at 650-696-5565.
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