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Personal Restraint

Date of Last Review: 5/19/08
SME: Associate Director of Nursing

Definitions: Personal Restraint (physical hold):

The application of physical force alone restricting the free movement of the whole or portion of an individual’s body to control physical activity. Personal restraint may only be used in emergency situations such a patient is a danger to self or others. Intervention and activities that are not considered as a personal restraints(physical hold) during a short period of time.

A. Escort:
An individual may be assisted to move from one location to another when guidance is needed. The individual must agree verbally or with gestures and be able to cooperate with the staff member who is assisting the individual to move.

B. Separation of two patients: Patients who are aggressive with each other and requires separating by staff member(s)

C. Administration of psychoactive meds under court order or in an emergency: A brief physical hold is not considered restraint for purposes according to the Texas Administrative Code provided that

1. The individual currently exhibits behavior that meets the definition of psychiatric emergency as defined in Chapter 405, Subchapter FF governing Consent to Treatment with Psychoactive medication or the individual is currently under court order allowing the facility to administer medication without consent and the medication ordered is permitted by the court order

2. The purpose of administering medication is active treatment to reduce symptoms of a diagnosed mental illness

3. Using medicine to reduce specified symptoms of a diagnosed mental illness is standard clinical practice

4. The specified medication and dosage ordered can be clinically justified in keeping with standard clinical practice and are appropriate for reduction of specified target symptoms; and

5. The physical hold is terminated as soon as the medication is administered.

Note: A Physical Intervention form is still required.

Responsibility:
Clinical staff of UTHCPC are trained annually in the use of personal restraint, mechanical restraint, and seclusion. Only trained, qualified staff may utilize the intervention

Procedure:

1. UTHCPC embraces the philosophy of least restrictive interventions. Verbal de-escalation is always considered before hands on intervention occur. Mechanical restraint is utilized only after all interventions have failed and is extremely rare in our institution. At times a patient may be held in a brief personal restraint (using SAMA ‘Hug’ or ‘elbow to hip’ containment) until the patient can be safely released.
   
2. Personal restraint order must be written by the physician if the personal restraint time period exceeds 5 minutes

a. Original order: A physician may order personal hold for a period of time not to exceed 15 minutes.

b. Renewed order: If the original order is about to expire and the clinically competent registered nurse has evaluated the individual face to face and determined the continuing existence of an emergency, the clinically competent nurse must contact the physician. A physician may renew the original order provided it would not result in the use of personal restraint beyond 30 minutes total.

 

3. When a personal restraint is used, staff members will act to protect the individual’s privacy as much as possible without compromising the safety of individuals or staff during the episode. During a personal hold, one staff member uses hug containment, or if patient continues to be aggressive, the elbow to hip containment is used whereby a second staff member assists so that one staff member secures the upper torso and one secures the lower torso.

4. The RN must supervise the personal hold and must be present for the duration of the hold. The RN is responsible for monitoring patient’s respirations to ensure that the patient’s airway is free at all times and that expansion of lungs is not restricted due to excessive pressure on patient’s back. (Note: If the RN is physically intervening in the personal hold/another staff member must perform before the monitoring).

5. The RN is to assess the patient post intervention and document this on physical intervention form.

Documentation

A. Personal restraint monitoring must be documented on the least restrictive measures checklist. The time initiated and time discontinued shall be documented. If the patient requires seclusion after personal restraint, a new form shall be initiated.

B. Physical Intervention form is also to be completed each time a staff member touches a patient.

C. The following information must be documented by nurse in the Seclusion and Restraint Progress Note Section:

1. behavior exhibited prior to the personal restraint (hold)

2. less restrictive interventions attempted prior to use of personal restraint.

3. patient response to the personal restraint

 

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Harris County Psychiatric Center University of Texas Health Science Center