SanFranciscoGeneralHospital&TraumaCenter AdministrativePolicy18.

09Restraints ApplicationDemonstrationCompetencyChecklist

Introduction:

ThepurposeoftheSFGHAdministrativePolicy18.09Restraintsanditscorrespondingapplicationdemonstrationtrainingisto ensuretheuseofrestraintsmaintainsasafeenvironment,preventsinjury,andmaintainsdignityofpatientsandstaff.

Restraintuseisnotwithoutrisks.Restraintshavethepotentialtocausephysicalandpsychologicalharm,lossofdignity,and evendeath.Pressureulcerformation,hypostaticpneumonia,constipation,incontinence,contractures,andneurovascular impairmentcanresultfromtheenforcedimmobilitythatresultsfromusingrestraints.Alteredsensoryperceptionandthought processesmayalsoresult.Humiliation,fear,anger,andadecreasedsenseofselfesteemmayoccur.

Restraintorseclusionmayonlybeimposedtoensuretheimmediatephysicalsafetyofthepatient,astaffmember,orothers whenallotherlessrestrictiveoptionshavefailedandmustbediscontinuedattheearliestpossibletime. Justaspatientbehaviorisnot100%predictable,noproductis100%foolproof.Patientsafetyrequiresregularreassessmentand monitoringperfacilitypolicy.Aproductthatworkedinthepastmaybeinappropriateifthepatientsmentalorphysicalhealth statuschanges. SFGHutilizesthefollowingtypesofrestraintsasappropriatetothecaresetting: o SofttieLimbRestraints o HandMittRestraints o Vest/TorsoRestraints o LockBuckleRestraints o PhysicalHold(Manual)Restraints Arestraintdoesnotincludedevicesorothermethodsforthepurposeofconductingroutinephysicalexaminations,therapeutic procedures,ortests.Anymeasureorinterventionusedthatcanbeintentionallyremovedbythepatientinthesamemanneras itwasappliedisnotconsideredarestraint: o o o o o o o o (IV)ArmBoards Mechanicalsupport Positioning/Securingdevice Ageordevelopmentallyappropriateprotectiveinterventions Physicalholdforconsentedmedication Stretcher/gurney/hospitalbedsiderails. PrescribedmedicationsnotmeetingdefinitionofChemicalRestraints Lawenforcementintervention

SanFranciscoGeneralHospital&TraumaCenter AdministrativePolicy18.09Restraints ApplicationDemonstrationCompetencyChecklist

Participant: Trainer: Date:

SOFTTIELIMBRESTRAINTS APPLICATIONDESCRIPTION
1. Preparethelimbholderbypassingthenarrowendthroughtheslitin thewideend.Pullthestrapthroughtheslitandfeedthroughtheloop attachedtothecuff.Thiswillcreatealoosecuffwiththesyntheticfur orflannelontheinside. Usingthestrapfromthewideendofthecuff,encirclethecuffand feedthestrapfromthewideendthroughtheloopintheopposite directionofthestrapfromthenarrowend. Placethepatientshandorfootthroughthecuff,tightenthecuffand securethehookandloopfastener.Thereshouldbeenoughspacefor thecaregivertoinsertonefingerbetweenthepatientandthelimb holdertoensurethatthepatientscirculationhasnotbeen compromised. Donottiethestrapsinaknot.Usethequickreleasetietechnique. Forwheelchairuse:attachtiestotheframeofthewheelchairusing quickreleaseties. Forbeduse:attachtiestothemovableportionofthe bed frame using quickreleaseties.Donotattachtomovablesiderails.

PASS

NOTES

2.

3.

4. 5. 6.

NOV2012

SanFranciscoGeneralHospital&TraumaCenter AdministrativePolicy18.09Restraints ApplicationDemonstrationCompetencyChecklist

Participant: Trainer: Date:

HANDMITTRESTRAINTS APPLICATIONDESCRIPTION
1. 2. 3. 4. 5. Insertthepatientshandintothemitt,palmdown. Wrapthewriststraparoundthesmallestpartofthe patientswrist, overthetopofthewrist,throughtheplasticring,andsecureitonto itself. Bringthesecondhookstrapoverthetopoftheloopstrap toforma doublesecurityclosure. SlideONEfinger(flat)betweenthedeviceandtheinsideof the patientswristtoensureproperfit.Thestrapmustbesnug,butnot compromisecirculation.

PASS

NOTES

NOTE Followsteps56foruseofoptionalbedconnectingstrap(hospitalbeduseonly)tohelppreventthepatientfromremovingthedeviceor inflictingselfinjury:

6.

Wrapthestraparoundthepatientswristorpassitthrough theloops onthemitt. UsePoseyQuickReleaseTietosecuretheendofthestraptoa movablepartofthebedframe.Donotsecuretomovablesiderails.Tie strapatapointmidwaybetweenthepatientswristandelbow,outof thepatientsreach.

NOV2012

SanFranciscoGeneralHospital&TraumaCenter AdministrativePolicy18.09Restraints ApplicationDemonstrationCompetencyChecklist

Participant: Trainer: Date:

VEST/TORSORESTRAINTS APPLICATIONDESCRIPTION
1. 2. 3. 4.

PASS

NOTES

Placethedeviceonthepatientwiththeopeningintheback.Make suresideseamsarelocatedunderthearms.Iftheyarenot,thesizing maybeincorrect. Closewiththezipper,orhookandloopfasteners. Securestrapstothewheelchairorbedframe,outofthepatients Reach. Slideanopenhand(flat)betweenthedeviceandthepatienttoensure properfit.Thedevicemustbesnug,butnotinterferewithbreathing.

WARNING Arestraintappliedincorrectlyorwornbackwardsmayresultinseriousinjuryordeathfromsuffocation,chestcompressionorpatientescape. NEVERcrisscrossstrapsdirectlybehindthepatient.Strapsmayloosenifthepatientrotates. Makesurestrapscannotslide,loosen,ortightenifthepatientpullsonthem,orifthebedorchairseatpositionisadjusted.

WHEELCHAIRUSE: a. b. c. d. Positionthepatientasfarbackintheseataspossiblewiththe buttocksagainstthebackofthechair. Bringthestrapsoverthehipsata45degreeangleandpassdown betweentheseatandthewheelchairsides(fig.1). Crisscrossthestraps,andusequickreleasetiestoattachstrapsto theoppositesidekickspurs,outofthepatientsreach(fig.2). Ifthechairhasanadjustableseat,securestrapstoamovablepart ofthechairframe,outofthepatientsreach.

BEDUSE: a. Securestrapswithquickreleasetiestoamovablepartofthe bed frameatwaistlevel,outofthepatientsreach.Donotsecure strapstomovablesiderails.

NOV2012

SanFranciscoGeneralHospital&TraumaCenter AdministrativePolicy18.09Restraints ApplicationDemonstrationCompetencyChecklist

Participant: Trainer: Date:

LOCKBUCKLERESTRAINTS APPLICATIONDESCRIPTION
1. PLACEMENT: Positionthepatientonthebed. Bringtheendsofthestrapdownthroughtheinsideofthesiderailsso theydonotinterferewhenthesiderailsareraised.Threadtheendof thestrapoverthetop,aroundtheframe,andthroughthelock.Make surethatthestrapsareattachedtoamovablepartofthebedframe, outofthepatientsreach.Donotattachtomovablesiderails. Pullthestrapsnugandclosethelock.Checkthatthelockclicksshut. Ifalockisnotcompletelyclosed,itcanpopopen.Beforeleavingthe patientsside,testthelockbytryingtoopenitwithoutthekey. APPLICATION:(repeatsteps1.through3.foreachlimb) Wraptheneoprenepiece(theblueorredsideshould bepositioned againsttheskin)aroundthewrist/ankle.Attachtheblackhookand looppiecestogether,followedbytheblueorredhookandlooppieces. Thefuzzypieceshouldbesandwichedbetweenthetwopiecesofhook (fig.1).Besuretooverlapatleastoneinch(3cm). Pressthehookandloopclosuretogetherfirmlyand makesureit adheressecurely.SlideONEfinger(flat)betweenthecuffandthe insideofthepatientswristtoensureproperfit.Thecuffsmustbe snugenoughtopreventescape,butnotinterferewithcirculation. Passtheendoftheshortstrapthroughthelockandadjustittothe desiredlength.Checkthatthelockclicksshut.Ifalockisnot completelyclosed,itcanpopopen.Beforeleavingthepatientsside, testthelockbytryingtoopenitwithoutakey. UNLOCKING:
NOTE: UniversalPoseyKeysMUSTbereadilyavailabletostaffatalltimes.Inanemergency,itisdifficulttocutthecuffswithscissors.

PASS

NOTES

2.

3.

1.

2.

3.

1.

InsertthePoseyKeyintothelockandturncounterclockwise.Thiswill preventjamming(fig.2).

NOV2012

SanFranciscoGeneralHospital&TraumaCenter AdministrativePolicy18.09Restraints ApplicationDemonstrationCompetencyChecklist

Participant: Trainer: Date:

PHYSICALHOLD(MANUAL)RESTRAINTS APPLICATIONDESCRIPTION

PASS

NOTES

WARNING Physicalholdproceduresisarestraintprocessthatisinitiatedwhenateamoftwo(2)ormoretrainedhealthcareprofessionalshavedecided torespondtoasafetyissue. Intheeventthatastaffpersonfindshimself/herselftobetheonlypersonrespondingtoanaggravatedassaultincident,thatstaffpersonwill needtocallforadditionalhelptorespondtothesituation.

1.

2.

3.

4.

Grasptheaggressorsarmattwopointsbytheirclothingbetween jointswheneverpossible,whileprotectingtheaggressorsbreathing andcirculation. Onepointshouldbeinlowerlimbnearwristorforearm.Grabwristor wrapptssleevesinstaffsgrip.Secondcontactsshouldbetheupper armornearshoulder.Theupperarmshouldbesecuredbystaffs innerarmcomingunderpatientsarmpitandup.Grabbingstaffsown clothingwithinnerarmismoresecure. Twostaffmembersatleastarerequiredtocontainupperlimbs,moreif allfourlimbstobesecured. Standslightlybehindandtothesideoftheaggressorwithkneesbent inaslightcrouchingposition. Maintaincontrolofthegraspedarmata45degreeangle downfrom thehorizon.Holdarmacrossyourchesttodecreasemovementofarm. Becautiousnottohyperflextheelbowwhentighteninggrip. Utilizeleverage/weight,andavoidcontestsofstrength.Usetwohands tosecureaggressorsonearm. Mostleveragecomesfromcontactpointbeingclosertostaffstorso thanpatients.Staffscombinedweightshouldhaveaminimumof200% ofthepatientsweight.

ProACT,Inc.

NOV2012