Restraints can be dropped without increased injuries
Restraints can be dropped without increased injuries
A thorough plan is required to eliminate restraints in a health care facility, cautions Joseph Mraz, MS, executive director at Susque hanna Lutheran Village in Millersburg, VA, the nursing home that recently became restraint-free. Creativity is key, he says.
Obviously, you could not just stop using restraints and leave it at that. Injuries would skyrocket, and your facility would bear substantial liability. Chemical restraints are another option, but Mraz says you’re cheating if you rely on chemical restraints instead of physical restraints. Either way, the patient is restrained.
Is it realistic to expect the total elimination of restraints? Won’t there be some patients who truly must be restrained? Mraz says those patients are rare. For almost all patients in nursing homes or other health care facilities, restraints are not needed, he says. "We don’t think we’re such a unique facility that we’re different from the majority of nursing homes out there. If we got one of those rare cases where it seemed restraints were needed, we would keep trying different things until we found the right solution. You have to be willing to try new and different solutions."
Mraz says combative patients often fight less when restraints are removed. While restrained, they often will urge other patients to help them and then will lash out when approached, risking injury to both. With no restraints, the same patient often will be much less antagonistic.
These are some of the ways that Susquehanna kept patients safe without restraints:
• Increased exercise to improve muscle tone and reduce the likelihood of injury if a patient did fall.
• Dietary changes to complement the increased exercise and improve strength and muscle tone.
• Building staff/patient relationships by assigning nursing assistants to work with the same patients each day. By getting to know individual patients and their families, the staff could accommodate their needs better and learn how to help prevent falls and wandering.
• Creative environmental changes to minimize the risk of falls. Susquehanna has put protective mats on the floor by patients’ beds, with the families’ permission, to reduce injuries when a patient is prone to climbing out of bed. In other cases, furniture legs were cut to lower the beds.
For one patient with diminished mental capacity, the family explained to the staff that he had been an avid gardener. He was physically unable to garden outside, but his desire to go outside and work in the garden prompted most of his efforts to get out of bed and wander. So the staff came up with a solution. They put a beanbag chair on the floor in his room and allowed the man to sit on the floor, digging into the beanbag chair with his hands as he imagined himself gardening. Satisfied that he was able to garden again, he no longer fought the staff and did not need restraints.
"Some might look at that scene and see it as a dignity issue, that perhaps we were being disrespectful to cater to his idea that he was outside gardening," Mraz says. "But, if you know the circumstances and that restraints might be the alternative, we see it as a good response. He and his family were much happier with that than with restraints."
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