1. Registered nurses shall be educated and will demonstrate competency in the provision of assessment, prevention, appropriate use of alternatives, and management of patients for whom restraint interventions may be necessary.
   
   
2. All nursing staff will be involved in the three phases of restraint: initiation, use, and termination.
   
   
3. Since patient rooms cannot be locked to provide seclusion, it is the responsibility of the nursing staff to maintain the patient's privacy and dignity and to protect the patient from others who may want to harm the restrained patient; from hazards such as fire; and to ensure that restraints are applied and maintained safely.
   
   
4. It is the responsibility of the nursing staff to initiate the problem on the nursing care plan "Potential For Injury" and to educate the patient/family. This is not required for the Emergency Department.
   
   
5. An RN may receive a written, verbal, and/or telephone restraint order from a licensed independent practitioner (MD,NP); utilizing the preprinted restraint order form prior to or, in an emergency, within 12 hours after application of restraints. The following information must be in the order:
   1. Type of restraint
   2. Reason for restraint
   3. Maximum duration the restraint may be applied.
      Note: PRN (as needed) orders are not acceptable.
      
      
6. Early release of restraints: when restraint is terminated early and the same behavior is still evident, the original order may be reapplied if alternatives remain ineffective and the original order has not expired. Document the reason for re-application of restraint.
   
   
7. The patient shall be continually assessed, monitored, and reevaluated.
   
   
8. Complete the 24 hour Restraint Flowsheet.
   
   
9. Send the second page of the 24 hour Restraint Flowsheet to the Director of Performance Improvement Program, PCS, at the conclusion of each 24 hour restraint period.
   
   
10. The Restraint Flow Sheet shall be used to document the frequency of observations as follows:
    
    

    Device	Frequency of Physician Orders	Frequency of Documented Observations	Frequency of documentation that fluids, toileting, ROMs have been offered
    Treatment restraints used to protect confined patients for their personal safety, from disrupting medical device, procedure, or wound. Also when a patient refuses postural, protective, or assistive device.	Every 24 hours unless covered by protocol	Continuous monitoring is documented at least every hour.	At least every 4 hours
    Involuntary behavioral restraints for violent assaultive behavior	Every 4 hours for adults. Within 1 hour of restraint initiation, the licensed independent practitioner must see and evaluate the patient. Every 4 hours for children 9-17 years. Every 1 hour for children less than 9 years. After 24 hours, the independent practitioner must see and assess the adult or child before initiating a new order.	Continuous monitoring is documented at least every 15 minutes	At least every 4 hours

Always follow UC Davis Medical Center's policies and procedures when restraining a patient.

Restrictive devices should be used only after a full assessment of patient's needs, with proper medical authorization, following all policies and procedures.

Use the patient's CARE PLAN to minimize restraints and maximize freedom. Use the LEAST RESTRICTIVE DEVICES when possible.

Monitor the patient frequently as stated in the policies and procedures.

DIRECTIONS:

1. Put Cuff firmly around patient's limb.
   
   
   
   
2. Completely encircle cuff with webbing strap. Always allow enough room for one finger to be inserted between cuff and patient's limb, making sure not to interfere with or cut off circulation.
   
   
3. Pass webbing strip through buckle.
   
   
   
   
4. Place strap around part of the bed frame using a quick release knot.