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Restraint And Seclusion Guidelines:
Rights Of People Receiving Voluntary And Involuntary
Behavioral Interventions In Mental Health Programs, Advocacy, Inc.:"There are some people who may get worse when treated with seclusion or restraint. Many people who have been physically and/or sexually abused fear being locked up or tied down because of bad memories. If you believe that you have good reason not to have seclusion and/or restraint used as a treatment for you, you must tell your doctor. You need to tell your doctor about the experience or issue that makes you believe you should not be treated with seclusion and restraint. You should tell your doctor before a need for seclusion or restraint arises. (See Advocacy's handout, How to Make an Advanced Directive.) There may be times when your doctor believes that you must be secluded or restrained, even though you think it will make you worse. When this happens, the doctor has to justify why he or she thinks seclusion or restraint is the only way to keep you and others safe and must write the reason in your medical record."
Mary Faithfull, Executive Director
7800 Shoal Creek Boulevard, Suite 171-E
Austin, Texas 78757-1024
(512) 454-4816 (Voice/TDD)
Fax: (512) 323-0902
(512) 454-0063 (TDD Answering Machine)
Intake: (800) 252-9108 (Voice/TDD)
http://www.advocacyinc.org/IR10.htm
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Use of Patient Restraints, The American College of Emergency Physicians (ACEP):"The American College of Emergency Physicians (ACEP) supports the careful and appropriate use of patient restraints or seclusion. ACEP recognizes that patient restraint involves issues of civil rights and liberties, including the right to refuse care, freedom from imprisonment, and freedom of association. However, there are circumstances when the use of restraints is in the best interest of the patient, staff, or the public.
Methods of patient restraint include physical restraints, chemical restraints, and seclusion. Patient restraint should be considered when a careful assessment establishes that the patient is a danger to self or others by virtue of a medical or psychiatric condition."
1125 Executive Circle
Irving, TX 75038-2522
800-798-1822 or 972-550-0911
972-580-2816 fax
customerservice@acep.org
http://www.acep.org/1,680,0.html
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Guidelines For Restraint Use, The American Geriatrics Society:"Physical or chemical restraints that inhibit voluntary movement are sometimes used in acute and long-term care settings with the goal to prevent injury and protect patients. The Food and Drug Administration (FDA) and Centers for Medicare and Medicaid Services (CMS) state that a protective restraint is any device that restricts a patient's movement and cannot be removed easily by the patient. All such devices must be labeled as to their intended use. Restraints include vest or wrist restraints, geriatric chairs with tables, side rails on beds, etc. Although the major focus of this statement is on physical restraints, the American Geriatrics Society advocates reducing use of all types of restraints. While the intended use of restraints is to "prevent harm," numerous studies have shown that restraints neither decrease the number of falls, nor ensure freedom from injury. The severity of injury may in fact increase in some restrained patients."
American Geriatrics Society
The Empire State Building
350 Fifth Avenue, Suite 801
New York, NY 10118
Phone - 212/308-1414 Fax - 212/832-8646
Email - info@americangeriatrics.org
http://www.americangeriatrics.org/products/positionpapers/restraintsupdate.shtml
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Instruments from the Program of Research on
Individualized Care/Restraint Reduction: 1986-1999, Center of Geriatric Nursing Excellence:"The Primary Nurse Questionnaire (PNQ)* is a structured interview guide used in one hospital study (Strumpf & Evans, 1988) to interview primary nurses about their specific patients who were subjects; content analysis was used to develop categories. No validity or reliability studies have been done on this instrument."
Monda M. Spool, MBA, MA
Administrator
Center of Geriatric Nursing Excellence,
University of Pennsylvania
School of Nursing - RM 317
420 Guardian Drive Philadelphia, PA 19104-6096
(215)573-3296
email: mspool@nursing.upenn.edu
http://www.nursing.upenn.edu/gero/tools.htm
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A Nationwide Pattern of Death, The Courant:"Roshelle Clayborne pleaded for her life.
Slammed face-down on the floor, Clayborne's arms were yanked across her chest, her wrists gripped from behind by a mental health aide.
I can't breathe, the 16-year-old gasped.
Her last words were ignored.
A syringe delivered 50 milligrams of Thorazine into her body and, with eight staffers watching, Clayborne became, suddenly, still. Blood trickled from the corner of her mouth as she lost control of her bodily functions."
http://www.copaa.net/newstand/day1.html
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Deadly Restraints, Commonly Used Terms, The Courant:"Physical restraint: A broad category of restraints in which a patient's movements are restricted by the use of physical force. This action is usually taken to prevent an upset or agitated person from hurting himself or others.
Mechanical restraint: A broad category of restraints in which a patient is immobilized through external devices such as straps, belts, wrist and ankle cuffs, or restrictive clothing such as straitjackets."
http://www.copaa.net/newstand/gloss.html
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National Restraint Death Database, The Courant:"A team of Hartford Courant reporters and researchers has compiled the following national database, which is believed to be the first of its kind.
Representing five months of research, the database is intended to shed light on deaths that occurred during or shortly after psychiatric or developmentally disabled patients were restrained or secluded. The database documents 142 deaths from 1988 to the present, as identified by public agencies, advocacy offices and news accounts. The reporting team focused on deaths in psychiatric hospitals, psychiatric wards of general hospitals, group homes and residential facilities for troubled youths, and mental retardation centers and group homes. "
http://www.courantclassifieds.com/projects/restraint/data.stm
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Restraints, Emedicine.com:"Restraints are any physical or pharmacological means used to restrict a patient’s movement, activity, or access to their body. Patients generally have a right to be free from restraints unless restraint is necessary to treat their medical symptoms or to prevent patients from harming themselves or others.
Restraining a patient raises serious concerns, such as infringement on patient autonomy, limits on freedom of movement, claims of battery, and risk of physical and/or psychological injury resulting from restraints. Therefore, before using restraints, health care professionals must carefully weigh the benefits of the restraint against the risks of the restraint, and they always should consider whether alternatives to restraint are available."
Emedicine.com Main Office
1004 Farnam Street, Suite 300
Omaha, Nebraska 68102
Office: 402-341-3222
Fax: 402-341-3336C
edit@eMedicine.com
http://www.emedicine.com/emerg/topic776.htm
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Patient Restraints Improving Safety, Reducing Use, FDA Consumer:"When Florence Carlson had a stroke and could no longer
walk, nurses at Augustana Home in Minneapolis said she needed a
wheelchair restraint belt for her safety.
Her daughter agreed, fearing that her 85-year-old mother
might fall and injure herself without such a device.
On Oct. 8, 1987, the same restraint that was supposed to
protect Carlson's health took her life."
http://openseason.com/annex/library/cic/X0002_restrain.txt.html
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Patient Restraint Devices can be Dangerous, Food and Drug Administration:"Every day, restraints are used on more than half a million people in
health care facilities, primarily to prevent falls or other injuries.
However, FDA has estimated that at least 100 deaths occur annually from
their improper use in nursing homes, hospitals and private homes. Most of
the deaths are due to strangulation. The agency has also received reports
of broken bones, burns and other injuries related to improper use of
restraints.
The agency's review of the reported incidents has shown that they may
have resulted principally from incorrect use, including inappropriate
patient selection, incorrect restraint selection, errors in applying the
devices and inadequate monitoring of patients when restrained."
http://www.fda.gov/bbs/topics/NEWS/NEW00280.html
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Ferno Wrist and Ankle Restraints:"Ferno Wrist Restraints: The Ferno Cot Rail Wrist Restraint fastens to the cot railand holds the patient's wrist securely to the top of the side rail.
Ferno Ankle Restraints: The Ferno Ankle Restraint fastens to both sides of the main cot frame and holds the patient's ankles securely in place with hook and loop closures."
http://www.life-assist.com/restraints/sx414.html
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Posey Limb Holders, Life-Assist, Inc.:"For mild limb control. These holders are easy to apply and economical. The cuffs secure with a hook and loop fastener, and a d-ring is used as a stress point with a double loop to prevent over tightening. The SX-2532 secures with a hook and loop fastener and comes with a quick-release buckle on both the cuff and the connecting strap. Washable."
http://www.life-assist.com/restraints/sx2510.html
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Posey Twice-As-Tough (T-A-T), Cuffs for Gurnies, Life-Assist, Inc.:"Combines the comfort and appearance of a "soft restraint", with the strength and effectiveness of leather. 2" Lycra cuffs are constructed of neoprene padding and color-coded for wrist or ankle. Washable."
http://www.life-assist.com/restraints/sx2750.html
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RIPP™ Medical Restrainers (Wrist Restraints):"RIPP™ Medical Restrainers are positive restraints that go on fast and secure firmly to bed or stretcher railing. Using an effectively designed, triple locking system, these restraints cannot be removed by a patient who does not have one hand totally free."
http://www.ripprest.com/mr.htm
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Safe Use Of Restraints And Seclusion For Behavioral Management, Medformation.com:"What do I need to know about restraints or seclusion? The caregivers will do a complete assessment on you when you are treated for a mental health problem. A complete assessment includes talking about your medical conditions, your medicines, and a physical check up. This will help caregivers decide what type of care is best for you. Following are things caregivers will talk to you and your family about restraints and seclusion."
http://www.medformation.com/mf/mm_qdis.nsf/qd/nd2339g.htm
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NAMI To Release Summary of Restraints & Seclusion Abuse Reports,
National Alliance for the Mentally Ill (NAMI):"The National Alliance for the Mentally Ill (NAMI) also will release separately a summary of abuse reports it has compiled since publication of the investigative series "Deadly Restraint" by The Hartford Courant in October 1998. The series surveyed 142 deaths around the country over the past decade that occurred during or shortly after restraints or seclusion were used.
http://bipolar.nami.org/update/990324.html
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Psychiatric Emergencies & Nursing Action, National Center of Continuing Education, Inc.:"There have been many changes over the last ten years in the facilities and resources available for treatment of patients with acute psychiatric problems. As mentioned, emergency rooms and designated crisis clinics have become both screening and treatment centers. General hospitals have developed psychiatric units or integrated admissions to medical units. The trend in most inpatient psychiatric units is short-term treatment based on the crisis intervention model.
Communities have developed a variety of other resources, which include residential programs as alternatives to hospitalization, halfway houses, day-or-night treatment centers, non-medical detoxification programs for alcohol and drugs, and crisis intervention centers."
http://www.nursece.com/onlinecourses/9225P5.html
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Patient Restraint and Positional Asphyxia Newz Directory:"A Comprehensive Directory of
Restraint Techniques and Restraint Asphyxia Information
(Restraint-Related Positional Asphyxia)."
http://www.charlydmiller.com/ranewz.html
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Restraint Asphyxia - Silent Killer:"Prehospital care providers often encounter agitated and violent patients. To ensure patient and provider safety and to facilitate thorough medical examination and care, these individuals require restraint. However, forcefully restraining a patient in the prone position or use of "hobble" restraint is not appropriate to medical care provision, according to many sources. Besides seriously interfering with access for examination and care, the use of forceful-prone or hobble restraint has been associated with patient death by "positional asphyxia."
http://www.merginet.com/tgp/2000/0011/feature-asphyxia-0011.shtml
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Seclusion and Restraint, National Institute of Mental Health:"The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to one's self or others. These extreme measures can be justified only so long as, and to the extent that, the individual cannot commit to the safety of themselves and others."
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Strategies For The Management Of Disturbed And Violent Patients In Psychiatric Units:"Seclusion is the supervised confinement of a patient alone in a room, the essence being the involuntary isolation of the patient. The Code of Practice (Department of Health and Welsh Office, 1993; paras. 18.15-18.23) would appear to narrow the definition to those occasions when it is used to protect others from significant harm. Although further restriction has been sought in a number of arbitrary definitions, seclusion should include those occasions when the door is open or unlocked as well as when the patient is locked in his room overnight. The breadth of the definition is important because the practice of seclusion is subject to very stringent control and recording in comparison to other procedures."
http://www.graap.ch/disturbed.html
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Use of Restraints/Protective Immobilization Devices:"To describe the guidelines for the use of restraints/protective immobilization devices in Harris Continued Care Hospital (HCCH). HCCH's goal is to reduce the use of restraints to the safest possible level."
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Restraint Application, NIH Clinical Center Nursing Department:"The professional nurse will:
1. Assess feasibility of maintaining safety using less restrictive measures; establish that these interventions are inadequate.
2. Assess need for continued restraint at least every two hours
3. Establish criteria for discontinuing restraints based on individual patient needs. Evaluate patient's progress towards meeting criteria.
4. With physician input, establish and implement a plan of care designed to eliminate need for restraints. Identify factors contributing to person’s continued behavioral dyscontrol. Address these needs in written care plan. Review plan of care for effectiveness at least every 8 hours. Upon discontinuing restraints, design a prevention plan aimed at fulfilling patient needs underlying behavioral dyscontrol, to limit or and prevent repeated use of restraints.
5. Provide input into multidisciplinary decision to contact family member/guardian regarding patient's status, if appropriate."
http://www.cc.nih.gov/nursingnew/nursingresources/RestraintSOP01.htm
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Your Rights in Hospitals Regarding Restraining and Seclusion:"What Is Restraint?
"Restraint" is physical force, mechanical devices, chemicals, seclusion, or any other means which unreasonably limit freedom of movement. Hospital staff may use four types of restraint to restrict patients who are acting, or threatening to act, in a violent way towards themselves or others."
http://www.psychiatry.com/mhlac/basicrights/restraintandseclusion.html
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