The Internet Journal of Emergency and Intensive Care Medicine™ ISSN: 1092-4051

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Physical Restraint: An Algorithm

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The University of Texas MD Anderson Cancer Center Restraints Improvement Group

Citation: The University of Texas MD Anderson Cancer Center Restraints Improvement Group : Physical Restraint: An Algorithm . The Internet Journal of Emergency and Intensive Care Medicine. 1999 Volume 3 Number 2

Rule
Algorithm
Assess Physical Factors
Assess Environmental Factors
Assess Psychological Factors
Assess Patho-Physiological Facto...

Beverly Mitchell RN, Joni Herman RN, Eden Bautista RN, Anna Mathew RN, Tracy Chien RN, Sara John RN, Anna Cherian RN, Mary Zacharih RN, Angela Arnold RN, Sirene Parreno RN, Maria Bunagan RN, Uselyn Deary RN, Gayle Balmaceda RN, Marian Wilson RN, Monique Vincent RN, The Quality Improvement Team, The Education Team, MICU & SICU Staff, Gregory Botz MD, Olivier Wenker MD

Rule

Treat or eliminate causes for abnormal behavior. The standard of practice is non- restraint except under unique circumstances after exhausting all reasonable alternatives.

Algorithm

Assess Physical Factors

Age Cognitive Level Sleep Pattern Nutrition: Thirst / Hunger Touch Comfort Physical Activity Evaluate Risk Factor And Anticipate Need Promote Normal Sleep Pattern Meet Needs Of Thirst And Hunger Or Substitute Other Alternatives Ie. Ice Chips Therapeutic Touch Pain ManagementRom/Physical ActivityTo Chair And Change Position Every 2 Hours

Assess Environmental Factors

Noise/Talking Lighting Placement Of Bed Arrangement Of Equipment Temperature Unfamiliar Objects Decrease Noise Level Tape Family Voices/Music Keep Day/ Night Light Pattern Visual Contact Of Patient Keep Equipment Out Of View Utilize Blankets/ Fans As Needed Religious Objects, Pillows And Blankets From Home

Assess Psychological Factors

Anxiety/Fear Fatigue Depression/Grief Denial Paranoia/Mania Boredom Communication Barrier Stress:Postoperative Hospitalization Socialization Keep Informed And Explain Procedures Rest Periods Consider Anti-Depressants And Re-Evaluate Medications Offer Tv / Radio Language Interpreter Utilize Family And Friends/ Hearing Aids/Glasses Explore Coping Mechanism, Reaffirm Plan Of Care Frequent Reality Orientation, Introduce Team Members Support Family Visitation

Assess Patho-Physiological Factors

Alteration In Cns Pulmonary Abnormalities Systemic Infective Processes Metabolic Disturbance Drug Intoxication: Therapeutic And Substance Abuse Endocrine Disturbances Nutritional Deficiencies Frequent Orientation Neuro Assessment Maintain Airway And Adequate Oxygenation Treat Infection/ Temperature Treat Electrolyte Abnormalities Review Medication And Look For Synergistic Reactions. Treat Withdrawal Treat Endocrine ImbalancesNutritional Support

References

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