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Hi Jodi:
1. Points to ponder:
a. OBRA requirements- " optimal safety and least
restrictive environment to all residents along with optimal
dignity"
b. Classification of restraints: Physical, Chemical
(psychotropics, use of sleeping pills for the night wanderers-uhhh!), and the
least talked about-deitary restraints (most restrictive: thickened liquids and
pureed/ least= normal diet consistency and thin liquids)
c. Restraints- anything patient cannot undo self to function
normally. Seat belt-if cannot undo, hand mits- if cannot hold on to things,
foot-buddy (yes, those leg positioners) if preventing him/ her to stand/
transfer; if otherwise the aptient would have been able to do so without the
application of such device. Also, stress on how you could distinguish between an
'enabler' and a 'restraint'. E.g: Enabler: One-sided bedrail to assist with bed
mobility/ patient can lower rail by self to facilitate sitting edge of bed.
Restraint: One sided bedrail to prevent falls (a pretty bad choice) or a raised
egde mattress/ body bolster to 'position' patient in bed. If the resident
cannot remove the 'positioner' to move/ function unrestrictively- it is a
restraint!
Common physical restraints:
1. Wedge cushion
2. Ischial step cushion
3. Pummel Cushion (heard it called saddle cushion,
too)
4. Foot buddy
5. Seat belt (unable to remove per self upon
command)
6. Lap buddy (unable to remove per self upon
command)
6. Posey vest/ jackets (ooh- hope you don't have
those)
7. Hand mits for confused patients messing with their
intubations
8. Bed rails (lots of literature on how this is also
dangerous/ fatal in some cases)
9. One side of bed against the wall- restricting movement from
one direction
10. Raised edge mattresses (if preventing mobility in an
otherwise mobile patient)
11. Body bolsters (guys- surveyors don't recognise
'positioners' as non-restraints unless it does not prevent mobility/ function.
12. Geri-chair for clients that can walk otherwise but cannot
transfer from a reclined geri-chair. 'Restraining' the wanderers?
13. Merry-walkers (well it doesnot stop them from walking!
Yeah, but can they transfer to bed or to another chair if they want
to?)
14. Padded bedrails- DOUBLE RESTRAINTS
15. Lap trays to prevent from standing-up per
self?
WELL THEN WHAT DO YOU CALL A LAP BUDDY ON A PATIENT WHO CANNOT
REMOVE IT BY SELF BECAUSE HE HAS SEVERE HAND CONTRACTURES AND HAS NO HAND
FUNCTION EITHER WAY AND HAS NO LOCOMOTION , TOO, BECAUSE OF HIS LEG
CONTRACTURES? Possibly a useless device that is normally classified as a
restraint and will generate an interest for the surveyors. My take is 99% this
patient may not need it and probably needs an OT for proper seating
positioning utilizing 'enablers' for appropriate midline approximated alignment
on wheelchair.
You could go over- the policy of your facility:
"restraint-free"/ "restraint appropriate" (goal of 'restraint-appropriate'
facilities- least AMOUNT of restraints for least amount of TIME- when
appropriate/ unavoidable and medically prescribed), the restraint reduction
program/ restraint alternatives- e.g: habilt training/ meal scheduling/
scheduled walks every 2 hours 8pm to 2pm for the night wanderers! Tilt in space
for the severely contracted patient that keeps falling forward and we have a lap
buddy on him? Non restraint alarm to alert staff for a client that forgets to
take is walker when he first gets-up, those 'cadillac walkers' with seats for
clients that have a compromised activity tolerance, need to sit every 2 minutes
and are otherwise cognitive enough instead of the merry walker? Why any
restraints- e.g. lap buddies, seat belts in dining room/
activities when being supervised by someone (least amount of time?) I am
sure you have a lot of your own.
Splints are generally seen as medically required devices for
increased safety/ support the weakened part or as corrective devices. Hence, do
not fit the 'restraint' definition as it is meant to improve medical safety/
function. You could go over the need for splints. Common types. Monitoring/
reporting protocols. Common donning/ doffing principles- I always like 'holding
hands' for a little while before you get the ring-on or the splint- prolonged
stretch (inhibition) versus quick-stretch (facilitation) to the muscle
groups/ tendons of which you want to decrease tone/ tightness. Also,
think of the confused patient's response to a sudden jerk- withdrawal- usually
trying to assime a fetal position (that's why we have more
flexor hypertonicity that extensor types)....
Regarding style of presentation:
How about everyone restrained (use a rope) to
their chairs, with glasses/ shades smeared with petroleum jelly (impaired
vision); all through out the presentation? During the course of your
presentation have a quiz on appropriate/ inappropriate use of
restraints and privelege the correct respondents by removing their
restraints....you will get the attention and the message accross!
O.T for a free world! Wish U luck!
Joe
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