Patient Restraints : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 3)

There is disagreement within the medical community about the extent to which restraints should be used, Cloud said, but most health professionals maintain that limited use of the devices can be beneficial.

Restraints assist immobile patients to maintain good posture, help prevent falls that lead to injury, keep dangerous patients from harming others, and provide some patients with a sense of safety.

Restraints can also help the elderly perform daily living activities, such as dressing and eating, and make it easier for health-care providers to perform certain medical procedures, such as changing intravenous lines or inserting nasal gastric tubes.

Danger Abounds

But despite their benefits, restraints can be dangerous if applied incorrectly or left on a patient too long.

Most problems associated with patient restraint devices can be attributed to poorly trained or inattentive staff, according to Mark Bruley, director of the Accident and Forensic Investigations Group at the Philadelphia-based Emergency Care Research Institute.

In many cases of injury, patients had been placed in restraints unnecessarily, allowed to wander unattended in some types of restraints for long periods, or placed in restraints inappropriate for their condition.

Other problems include health workers choosing the wrong size or style restraint, tying it too loosely or too tightly, or putting it on backward, all of which can result in injury and death.

"The main three problem areas we've noticed have to do with health workers applying them [restraints] incorrectly, using the wrong size, and not securing them to the bed," Bruley said.

"In some cases it's a systems problem. Patients have been choked to death by the restraint or bed rail because no one was paying attention. In other cases, patients have tried to get out of their restraints and injured themselves. It's a matter of providing better staff training."

Some health-care facilities teach workers how to correctly apply restraint devices, but others do not.

"I see the greatest problem with nurses and their aides," Bruley said. "Often times a restraint is applied for convenience. It enables staff to do other things without having to look at the patient as often as they should."

Marian A. Parrott, M.D., associate professor of geriatrics in George Washington University's Department of Health Care Sciences, Washington, D.C., said that restraint use is more reflective of staff attitude.

"It's a matter of how much risk they're willing to take," said Parrott, who is also an internist. "They're afraid of being found at fault if a patient falls."

Federal law requires that restrained patients be repositioned every two hours, but there are occasions when they are not moved for longer periods, Parrott said. As a result, some develop health problems such as nerve damage and incontinence.

They can also develop bed sores, loss of muscle tone, and depression.

"If a patient sits in the same place long enough, he can get into all kinds of contorted positions," Bruley added. "Once that happens it's very easy for the patient to get hurt."

One of the fastest-selling and most often used restraints is the V-neck vest. It costs between $8 and $14 and is more comfortable than many others.

The vest, which is produced by several of the largest manufacturers of restraint devices, is made of cloth or mesh, crisscrosses the patient's chest, and is tied to a bed or chair with straps.

But while it is designed to keep a patient from tilting forward or falling out of a chair, the vest's cotton canvass material "has a lot of play," often collapsing and squeezing against the neck or stomach.

Similarly, the straps used to secure the vest can entangle, strangling a patient.

"We didn't know that they were as dangerous as they are," said Joanne Rader, R.N., a clinical specialist at Benedictine Institute for Long Term Care, Mount Angel, Ore., and an assistant professor at Oregon Health Sciences University. "People weren't well-educated." estrained are safer than those who are not, and many health practitioners feel that alternatives to restraints should be the first option.

"You have to begin by assessing the patient's situation," Parrott said. "Rehabilitative approaches, like physical therapy, or an environmental approach, like safer chairs, lower beds, and safer floor material should be looked at first.

"For wandering patients you could set up a special area. This would make it easy to monitor them without restricting their movement."

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.