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Restraints require judicious use, documentation
Recent DNV surveys found two areas for improvement when documenting prolonged restraints and less restrictive alternatives.
Recent DNV survey findings at Asante revealed opportunity for restraint documentation. There are a lot of details in restraint documentation that help maintain safety for all involved. Here are two areas that DNV identified for improvement:
- Prolonged restraint requires consultation and must be documented in the restraint flowsheet by the nurse.
- Medical, nonviolent restraint orders are renewed every 24 hours. After four days of continuous restraint for nonviolent behavior, the case is reviewed by the treatment team and alternatives are explored to reduce or discontinue the use of restraints.
- After 24 hours of continuous restraint for violent or self-injurious behavior, a second physician must conduct an examination and provide a second opinion. Nursing should verify this consult was completed and documented in a provider progress note.
- Less restrictive alternatives to restraint use are required to be documented in the restraint flowsheet every two hours.
- Reminder: Upon initiation of restraint or seclusion, every field on the restraint flowsheet must be completed within 60 minutes by an RN. Thereafter, all the fields highlighted in pink must be completed every two hours by the RN or LPN for nonviolent restraints or the RN for violent restraints.
For more information on restraint and seclusion, please see the resources below or email Cr****************@as****.org.
Resources:
- Restraint and Seclusion, 400-PCS-NURS-0863
- NEW: Restraints for Violent or Self Destructive Behavior Fast Facts, 400-N-2068
- Mechanical Restraint Application for Violent or Self-Destructive Behavior, 400-PCS-NURS-0871 (new appendix includes photos of application instructions)
- Posey Limb Holders Application Instructions
- Soft Limb Restraints Fast Facts, 400-N-1120
If you have a question, please contact the author or relevant department directly.
