- Published: 06 January 2016
“We have a fair number of clients that call asking if a tray table or side rail is OK to use with their loved one. If the tray or rail restricts movement and no one is around to monitor their loved one, it might cause injury,” said Priscilla McDonald, RN, Clinical Assessment and Evaluation specialist at LifePath. “There are better ways to keep loved ones safe.”
History of Restraint Usage
It used to be routine to use a bed tray, bed rail, Posey vest or even a bed sheet to restrain a person who might be active but not safe getting up and moving about alone. In recent years injuries and deaths of individuals in restraints have caused the medical community and government agencies to rethink the use of restraints. In 1987 Congress passed a law that granted nursing home residents “the right to be free” of restraints and barred their use for discipline or convenience. As a home care agency, LifePath works within these same guidelines.
What is a restraint?
The FDA defines a protective restraint as “…a device including but not limited to a wristlet, anklet, vest, mitt, straight jacket, body/limb holder, or other types of strap that is intended for medical purposes and that limits the patient’s movements to the extent necessary for treatment, examination, or protection of the patients or others.” A protective device should not be used to prevent accidental injury, even if the injury to be prevented might be due to a medical condition, nor is it to be used for a behavioral restraint.
- Items that are considered restraints are a locked bedside table, Posey vest, locked seatbelt or sheet tied to keep a person in a chair or bed, a full bedrail, a heavy table in front of a wheelchair or chair that makes movement impossible.
- Items that are not considered restraints include braces or splints that people use to support or steady limbs so they can do their activities of daily living. These items are considered personal appliances.
Medications that prevent a person from moving on their own may be considered “chemical restraints.” These must be prescribed and monitored by doctors and given by care providers only as directed. A restraint like a bedrail for a client who cannot move on their own, like a hospice client at end of life, or a person with a spinal cord injury who cannot get up on their own, is not considered a restraint.
Alternatives to traditional restraints
“Sometimes restraints are medically necessary, but in that case there are strict guidelines of use. The person in restraints must be monitored constantly, released from restraints periodically, repositioned to avoid pressure sores and more. Even with full time monitoring accidents and death can happen,” said Ms. McDonald. If there is someone you care for who you think is unsafe, Ms. McDonald suggests asking two questions: “Why do I want to restrict movement?” and “What is the most dignified and respectful way I can keep my loved one safe?”
“People have the right to a dignified quality of life without restraints,” said Ms. McDonald. “When a person, especially a person who is confused, is restrained, they experience anguish and fear. Agitation can increase, and it’s hard to explain to them that you are trying to keep them safe.”
Restraints can make people feel socially isolated and lose the ability to maintain relationships. If used too frequently, people will lose physical function (like strength and joint movement) if they are just restrained. There are many alternatives to traditional restraints that are safe and effective. They include:
- In wheelchairs or regular chairs, using a seat cushion that slopes backwards can give a person some ability to reposition themselves but not get up unassisted. Nonslip cloths (like dycem) can be placed between clothing and a wheelchair cushion to prevent sliding.
- “Scoop” mattresses with a dip in the middle can be used on a bed or on the floor.
- Pants made with hip and pelvic padding can be used to cushion a fall if it occurs due to tripping, which is often seen in persons with dementia or Parkinson’s disease.
- Mattresses can be put on the floor, and pads can be put around mattresses.
- If rails or half rails are used to help people move in bed or to help caregivers reposition people, the rails should be evaluated for entrapment risk. If a limb is entrapped, it could be damaged by pressure and impaired blood flow. Entrapment has occurred through bars of a siderail, between a siderail and mattress, between headboard or footboard and siderail or mattress. Covers and protective barriers should be used to fill in the gaps and prevent entrapment.
- Baby monitors can be used by caregivers.
"Restraints should never be used so a caregiver can run to the store. That’s when accidents happen,” said Ms. McDonald.
By law, Franklin County Home Care staff are not allowed to provide services to people in restraints. If a client has restrained a loved one, an evaluation should be done to make sure the loved one is in the correct environment.