Other ways of "restraining" that I've met, in NH and hospital - more subtle maybe, but just as radically affecting the person )-:
- Denying/delaying to help patient/resident transfer from (wheel)chair to bed, or from bed to (wheel)chair. - Placing resident in a chair she can't drive when able and wanting to drive own wheelchair. - Not offering waterproof seat cushion in powerchair to resident that sometimes wets his pants - in order to "teach him not to". (So, when he did anyway, he would be "grounded" indoors for days in a manuel chair he could hardly drive.) I guess those examples goes to show that restraining is not always something we do - could as easily be something we didn't!! cybs/susanne, denmark ----- Original Message ----- From: "Joe Wells" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Monday, June 23, 2003 3:59 AM Subject: Re: [OTlist] I have to do an inservice 6/26 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 *****************************��********************************** To remove yourself from the OTnow mail list, send a message to: [EMAIL PROTECTED] In the message's *body*, put the following text: unsubscribe OTlist - List messages are archived at: http://www.mail-archive.com/[EMAIL PROTECTED] *****************************��***********************************
