The orthopedic team at the Misericordia Community Hospital is moving towards a restraint-free environment.
Many orthopedic patients are elderly and very frail, and have cognitive impairment. The team found that applying restraints actually increased patients’ risk for injury.
Broda chairs have high backs and deep seats that offer a lot of support for patients who want to get out of bed but aren’t quite ready for a wheelchair. The teal lap belt can be removed from the chair as it is no longer automatically used for patients.
“If [patients] wanted to get out of bed, they would climb over their bed rails and fall from a greater height,” explains Carla Genereux, RN and Elder Friendly Care Project Co-ordinator. “The lap belts restricted movement and caused agitation and skin tears.”
After conducting three spot audits in 2015, Carla found that 75.63 per cent of patients over the age of 65 were restrained. Many had dementia.
An example of a soft restraint that can be used to tie a patient’s ankles and wrists to a Broda chair or to their bed rails.
“Sometimes we’d hear patients call for help and we’d run into their room,” says Eleonor Beltran, LPN. “We’d see that they were fine, but they were just frustrated and wanted to get out of their restraints.”
To improve seniors’ outcomes and the care given to the senior population, Carla began staff education in October 2015. In cases where patients still require a restraint, staff must first follow the policy, conduct a thorough assessment and have a doctor’s order.
The team now uses alternatives to restraining—simple things such as patients eating breakfast and lunch together or sitting in the hallways instead of alone in their rooms. This change has been most beneficial for patients with cognitive impairments.
Shelley Macdonald, RN, lowers patient Dorothy Sherbank’s bed rails as part of the least-restraint policy.
“The patients keep each other company so they don’t get lonely, agitated or scared,” says Carla.
During the second round of audits in April 2016, Carla found that restraint use had decreased by 84 per cent.
“When the restraints were taken away, I was concerned at first,” admits Shelley MacDonald, RN on the unit. “But I’ve seen a big change in the patients because they’re not strapped down. They have freedom to move around and they’re more co-operative.”
Eleonor and Shelley agree that their patients are much easier to work with, more pleasant, less stressed and less anxious.
There has also been an increase in family involvement in care. Patients without a restraint can stay safe under the supervision of their loved ones. Families can ask staff questions about the new least-restraint practice.
Other initiatives to enhance Elder Friendly Care include delirium screening, delirium prevention, early mobility, reconditioning and medication review. These efforts can decrease complications and readmissions. Facilities across Alberta are hoping to adopt this practice in 2017.
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