Lecture on Fall Prevention and Restraints

Introduction

• Speaker: Maris
• Focus: Fall prevention in hospitals and at home, and the use of restraints
• Reference: Fundamentals of Nursing flashcards (starting on card #75)

Fall Prevention in Acute Care Settings

• Hourly Rounding: Check on patients regularly to ensure they are safe and have what they need.
• Patient Placement: Move confused patients closer to the nurse's station.
• Environment:
  • Keep floors clean, dry, and uncluttered.
  • Lock beds in the lowest position.
  • Use bed alarms for high fall-risk patients.
• Accessibility: Ensure essential items (water, glasses, etc.) are within reach.
• Footwear: Provide non-slip, well-fitting footwear (e.g., hospital socks with grippy bottoms).
• Orthostatic Hypotension: Encourage patients to sit and dangle legs before standing.

Fall Prevention at Home

• Environment Changes:
  • Remove scatter rugs.
  • Ensure good lighting, especially on stairs.
  • Use colored/reflective tape on step edges.
• Electrical Safety: Tape down electrical cords.
• Safety Equipment: Install grab bars in showers and non-slip mats.
• Assistive Devices: Ensure patients understand how to use them properly.

Restraints

Types of Restraints

• Physical Restraints: Items like vests or hand mitts.
• Chemical Restraints: Medications like benzodiazepines or antipsychotics.

Order Requirements

• In-person assessment by provider every 24 hours.
• No PRN orders.
• Documentation of rationale, patient assessment, and care offered.

Nursing Care and Assessment

• Alternatives First: Start with less restrictive measures (distractions, moving patient closer, etc.).
• Tying Restraints: Use slipknot on bed frame (not side rails or moveable parts).
• Frequent Assessments: Assess every 15 minutes to prevent issues like positional asphyxia.
• Regular Care: Every 2 hours, take vital signs, provide range of motion, and offer fluids/toileting.
• Discontinuation: Remove restraints when no longer needed, checking skin integrity by removing one restraint at a time.

Legal and Ethical Considerations

• Avoid false imprisonment.
• Ensure actions are medically necessary and justified.

Conclusion

• Importance of understanding fall prevention and restraints for patient safety and nursing exams.
• Next video topic: Skin integrity and pressure ulcers.
• Encouragement to subscribe and engage with the content.