Restraints and Falls Alternative Interventions - …

1 Restraints & Falls : Alternative Interventions Definition: Any manual method, or physical or mechanical device, material or equipment attached or adjacent to the resident s body that he or she cannot remove easily which restricts freedom of movement or normal access to one s body. (RAI Manual, pg 3 198) Reducing or eliminating Restraints requires a thorough assessment preferably by your interdisciplinary team. (Use the Restraint Elimination Assessment form to spur team discussion). Complete a full resident assessment before selecting Interventions . Following assessment, refer to this chart for suggested Interventions to avoid Restraints utilization and/or reduce Falls . This chart is divided into the following intervention categories, review each section for Interventions specific to each resident: o Resident Interventions o Family Interventions o Environmental Interventions o Staff Interventions After you have implemented an intervention, carefully and frequently monitor the resident to evaluate the effectiveness of these Interventions and revise your plan of care accordingly.

2 General Principles Restraints lead to further decline. Secure staff buy in. (Refer to Restraints : Staff Attitudinal Survey, web resources) Teach that all staff are responsible for restraint reduction and Falls prevention. Individual assessment is absolutely key. (Refer to Restraint Reduction Assessment form) Finding all the causes for behavior and using multiple Interventions have best outcomes. Put into place at least two Interventions when removing Restraints . All Falls cannot be prevented. Focus on preventing or reducing injury. Play to resident s strengths. Apply the Five Magic Tools, (Know what the resident likes to See, Smell, Touch, Taste, Hear). Be calm and self assured. Involve the family. Recommend a task or activity. Use pets, children and volunteers. Re direction and activity based upon residents work/career and/or interests.

3 Provide sense of security. Know resident s agenda. Encourage independence. Offer choices. Restraints & Falls : Alternative Interventions : page 2 Resident Interventions Sliding/leaning from chair Unsafe mobility/gain fall out of bed Agitated or abusive Elopement risk Pacing, wander Did you complete a full resident assessment before selecting Interventions ? (Refer to Restraint Elimination Assessment form) Evaluate for restorative programs x x x x PT/OT/ST consultation x x x Refer to social services, psychologist/psychiatrist x x Toilet! Toilet! Toilet! Teach residents correct method to sit on toilet not until back of legs touch seat, then place hands on rails and sit slowly. Establish toileting schedule x x x x x Adequate hydration Water! Water! And More Water! x x x x x For the feet: Footwear fits and in good condition Do choose footwear with: non skid soles; heels no higher than inches; with laces or Velcro fasteners; Avoid footwear with: extra thick soles; soles that stick or catch on floor surfaces; open toes for those with significant peripheral vascular disease If walking in stocking feet, choose socks with non slip bottoms Check non slip surfaces at regular intervals Residents with shuffling gait, such as Parkinson s, shoes with smoother soles Soft, flexible moccasins or non slip socks may help cognitively impaired to feel floor and compensate for decline in senses; however, may negatively impact balance Keep toenails trimmed x x x Determine why resident is uncomfortable and relieve the discomfort.

4 X x x x Place glasses on resident daily to enhance vision x x x Keep belongings within residents reach as well as call bell, water x x Place resident in bed when tired. x x x x x Instruct/assist residents with potential for orthostatic hypotension to: Rise from sitting/lying position slowly Dangle before walking Ankle pump in sitting position before walking Sit immediately if feeling dizzy Wear elastic stockings Elevate head of bed prior to getting out of bed x Anticipate customary routines or schedules and allow for preferences (late sleepers, early risers). Establish routines that fit with resident preferences and maintain that schedule x x x x x Avoid sensory overload x x Restraints & Falls : Alternative Interventions : page 3 Resident Interventions Sliding/leaning from chair Unsafe mobility/gain fall out of bed Agitated or abusive Elopement risk Pacing, wander Moving to different environment (more quiet, more familiar) at intervals x x Provide rest periods or nap schedule x Provide opportunities for companionship or 1:1 visitation x x x x Encourage resident to reposition frequently or help them reposition x x x Try other activities to divert attention based on resident s past role/activity interests.

5 See these sources for suggestions: Restraint: Activity Boxes document at Create boxes based on reminiscence or memories. Try This: Therapeutic Activity Kit at x x x Individualized and periodic exercise programs throughout day: Balance training consider Tai Chi Strength/gait training especially for lower extremities Encourage/assist to do stand and sit chair repetitions 4 5 times/day. Restorative walk to dine program Restorative active or passive ROM to upper & lower extremities Joint mobilization techniques, consider slow, prolonged stretching preceded by heat or ultrasound Evaluate possible weakness from previous fx or CVA, arthritis, seizures, Parkinson s, hypothyroidism, anemia x x x Structured high energy activities and subsequent relaxation activities, alternating rest and activity periods. x x Exercise pedals while sitting x Provide distractions while waiting such as exercise or pre meal activities x x Consider Wii interactive video games as exercise/activity ( ) x x x x Consider dance therapy, music therapy, singing or other rhythmic movements as an exercise/activity x x x x x Provide daily ambulation programs Group ambulation programs, accompanied walks inside or out doors x x x Consider hip protectors (soft padded clothing type are most easily tolerated by those with dementia)

6 , knee pads, elbow pads, wrist splints, and soft foam helmets to reduce serious injury x x x Provide cues or repeated reassurance Name and photo outside room Verbal and written reassurance about where the resident is and why x x x x Large number clocks and calendars to orient to customary routines x x Use relaxation techniques (tapes, videos, soothing music, lava lamp, white noise machines, active mobile, fish tank) x x x x Use reminiscence/life review x x x Tapes of loved ones and friends. x x x Restraints & Falls : Alternative Interventions : page 4 Resident Interventions Sliding/leaning from chair Unsafe mobility/gain fall out of bed Agitated or abusive Elopement risk Pacing, wander Provide spiritual support x x x x x Provider intergenerational, cultural or pet programs and activities x x x x x Remove objects that trigger resident to leave: coat, hat.

7 X Limit caffeine x x Consider Day Treatment Program x x Restraints & Falls : Alternative Interventions : page 5 Family Interventions Sliding/leaning from chair Unsafe mobility/gain fall out of bed Agitated or abusive Elopement risk Pacing, wander Family education at See brochures: (a. Making the Right Choice; (b. Safety Without Restraints : fall and Restraint Facts for Residents and Families; (c. Bed Safety Video library at Dept of Health & Senior Services for free loan of the Everyone Wins series of 6 videos about restraint use in the nursing home. Older, but still very relevant. or 573 751 6048 x x x x Involve family in planning care Teach about predicted course of illness, anticipated behavior changes d/t cognitive loss. Ask family to provide past habits and customs Coping mechanisms or triggering events x x x x x Encourage use of family/sitters to stay with high risk or confused resident x x x Ask family to record a reassuring message on tape.)))

8 X x x Ask family to compile scrapbook or box of photos, memorable events or objects of affection x x Restraints & Falls : Alternative Interventions : page 6 Environmental Interventions Sliding/leaning from chair Unsafe mobility/gain fall out of bed Agitated or abusive Elopement risk Pacing, wander Create a home like environment, personalize rooms, provide familiar objects x x x x x Relocate high risk residents to room close to nurses' station or plan care/activities to keep that person in view at all times. x x x x x Call light system in place x x x Use bedside commode (especially at night) Minimize distance between bed and commode Remove wheels from commode x x x Use adjustable height beds Keep at lowest level; only raise when giving care to save staff s backs Remove side rails Very low bed should be 7 13 off floor with high impact mat on floor Resident should be able to touch toes to floor at least Teach staff to raise bed for all care and lower when completed x x x Avoid full length side rails.

9 Consider trapeze bar, bed handle or bar, transfer pole, or half or quarter length side rails. x x x Consider full body pillows or long immobilization bags Use concave mattress or bed bolsters, pillows or rolled blanket under edge of mattress x x If one side is weaker, place bed against wall to encourage exiting from stronger side x x x Explore new technologies to prevent injuries from Falls ( , soft flooring, motion sensors in floor/room, room monitor, etc.) x x x Ensure necessary items are in reach: call bell, water pitcher x x x x Bedside/over bed table in reach water, tissues, providing diversion activities x Simplify environment. Clutter free rooms and hallways x x x x Frequent rest areas in halls and larger rooms X x Reduce external stimuli , particularly noise (overhead paging, TV, radio, noise, etc) x x Mat on floor by bed x x x Pad edges of furniture to prevent bruising x x x Carpet all hard surfaces or non skid wax Use low buff on waxed floors to reduce glare x Non skid strips on floor in front of sink, toilet, by bed, under bed wheels.

10 X Visual barriers or murals x x Exit doors Keep exit door closed Equip with alarm or warning system for staff notification Door guards Barrier stripes, or stop signs x x Restraints & Falls : Alternative Interventions : page 7 Environmental Interventions Sliding/leaning from chair Unsafe mobility/gain fall out of bed Agitated or abusive Elopement risk Pacing, wander Avoid mirrors and glass x Safety (grab) bars in bathroom and hall check space (rail to wall) x x Higher seated lounge chairs and toilets x x Ensure chair is appropriate in size and fit Use Alternative seating Consider using three different types of chairs per day. Lounge or winged chairs and sturdy rocking chairs for anxious residents x x x x Lock all equipment with wheels Lock or remove wheels from bed Remove wheels from chairs x x x Provide visual cues to aid in wayfinding Hang large print safety posters in room to encourage asking for help Large print signs for common areas Close doors to resident rooms or put strips on doors to prevent trespassing Room identifiers Visual cues for safe areas x x x x Use memory trigger devices to remind resident to get up slowly and carefully, use assistive devices, etc.