Critical Care -LUHFT
Occasionally, due to agitation, anxiety, confusion or delirium associated with their critical illness, Critical Care patients require restraint to keep them safe from harming themselves or to prevent inadvertent removal of essential lines and tubes.
This leaflet explains the types of restraint used in Critical Care, why your relative may have them and how we decide when they are needed.
What is restraint?
Restricting a person’s movement or behaviour is known as restraint. Restraint is an intervention that prevents a person from behaving in ways that threaten to cause harm to themselves, to others or to hospital property and/or equipment. There are may different types or restraint but the ones most commonly used in Critical Care are physical and chemical with the administration of medication.
Chemical restraint/Medication
Depending on a patient’s illness, they may need to be sedated to enable us to provide treatment such as ventilation. We also use sedative medications to help manage agitation and confusion. Patients are at times commenced on regular medications and sometimes given “one off” doses if required to help alleviate the situation and calm the patient to ensure safe treatment can be delivered.
Physical restraint
Physical restraint may be used to enable us to provide safe care and treatment when a patient does not have mental capacity.
Bedrails
Bedrails are used to keep patients in the bed and to reduce the risk of falls. They are also used at times to stop people getting out of bed for their own safety due to the risk of removing lines or breathing support.
1:1 observation
We may require someone to sit with your relative at all times to stop them from getting out of bed, removing their tubes and to re-orientate them regularly to reduce confusion.
Boxing gloves/restraint mitts
Restraint mitts are soft padded protection worn by the patient on one or both hands. Restraint mitts can help us to reduce the amount of sedative medicines required while preventing self-harm
Why does my relative require the use of restraints?
Due to your relative’s illness and the medications they have been receiving during their Critical Care admission, they may not be aware of their treatment or be able to consent to the care that we are providing. Your relative may have a number of tubes and lines in place as part of their treatment and if they were to remove these then that would not be in their best interest and potentially could lead to more harm.
Nursing staff will have tried other methods to try and keep these lines in place such as reassurance, explanation and orientation or distraction and will also looked to identify the cause of distress or confusion but sometimes mitts will need to be used to ensure that patients receive the treatment they need and stop them from pulling out their lines or their breathing tube.
Restraint mitts can also be used when the Critical Care team decide it is time to reduce the patient’s sedative medication. For example, when a patient’s condition has stabilised and the team want the patient to wake from their “induced coma”, restraint mitts might be helpful as the patient adjusts to their environment and situation. It is distressing for patients to have tubes inserted repeatedly. Using mitts can help to stop this happening. The decision to use mitts will only be made when it is felt by the team providing care to your relative that it is in their best interest.
We may also require the use of equipment to help us to keep your relative in bed and reduce the risk of falls.
When will they stop being used?
We assess the need for restraint continually. As soon as we feel they are not required or we can remove some elements then we will do so immediately. The use of the restraint has to be proportionate to the risk if the restraint was not in place.
Are restraints safe?
When restraints are in use, regular checks are completed by the medical and nursing staff including documentation of the patients understanding and capacity, regular skin checks and breaks from the restraint. The use of restraint is in place to enhance patient safety.
Will the use of restraint upset my relative?
There may be a short-term annoyance with the boxing gloves for example but this is compared to the risk of the individual pulling out lines and tubes that are essential to provide the care they need and that would need to be replaced.
The use of restraint is only used when deemed necessary to keep a patient safe from harm and for the minimum amount of time possible.
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