NO, never, not ever. Check the INS standards of practice on this issue because this is firmly stated that handboards are not restraints and there is a reference from JCAHO about this. I firmly believe that the lack of handboard use is the primary cause of the majority of infiltration/extravavation injuries that I deal with in lawsuits. They have to be used to reduce these serious risks. More than 50% of major and minor PIV complications occurs in the hand and wrist area! We can not ignore this any longer. Can you tell this is my soapbox!!
Is there any difference between INS standards and JCAHO definitions of restraints? We have so much education about restraints and having physician orders for restraints.
I wonder if this is where the differnce in opinions about restraints are ......of the standards ..........or of patient safety goals apply.
NO, the Standards Committee used the JCAHO standards to write this standard. Anything to immobilize a joint for medical purposes is NOT considered to be a restraint. Look at the INS standards and look up the JCAHO reference. A handboard is not now, nor has it ever, been consider to be any form of a restraint!!
BUT.....According to JCAHO those immobilizers used on joints (specifically anything that restricts bending and movement of extremities) ARE considered restraints. Our pediatric RNs are going to have to find something else to keep the kiddos from pulling their PIVs, PICCs, NGs, ETTs, and chest tubes, etc out. Any ideas????
I use armboards as necessary on our peds patients and do not consider them restraints but part of the securement of the PIV. Usually there is no restriction on movement of the extremity--they can be placed so that the wrist is immobilized but the fingers are loose so that the child can still grasp to color, eat, etc. I find that often a board is placed to immobilize more of the extremity than neccessary. And I never place boards on feet. I agree with Lynn and don't think there is anything else that can serve the same purpose.
As far as pulling NGs, TPs. etc out, hand mittens are effective for some kids. We just don't have a big problem with kids pulling out lines or anything else. It does happen but then we address it on an individual basis rather than assume all patients will act the same way.
Lynn: I have this debate with people all the time. When I mention to nurses I am training that they must use an armboard to immobilize a joint when an IV is inserted at that point, they often act like I am suggesting a medieval torture device, and many of them claim that this is considered a restraint "in their state". Is there a state that legally defines an armboard or handboard as a restraint? How can I prove to those who are deluded that they are incorrect? I would need something to disprove their individual "state law" beliefs. -LA
I am not aware of any states that have any rules or regulations about this, but I could definitely be wrong. I would insist upon those people providing this information to me. In the meantime, I use this statement from JCAHO
"Restraint used for the protection of surgical and treatment sites in pediatric and adult patients are not considered restraint." This statement is taken from http://www.jointcommission.org/AccreditationPrograms/BehavioralHealthCare/Standards/FAQs/Provision+of+Care+Treatment+and+Services/Restraint+and+Seclusion/Restraint_Seclusion.htm and scroll to the end of that page.
NO, never, not ever. Check the INS standards of practice on this issue because this is firmly stated that handboards are not restraints and there is a reference from JCAHO about this. I firmly believe that the lack of handboard use is the primary cause of the majority of infiltration/extravavation injuries that I deal with in lawsuits. They have to be used to reduce these serious risks. More than 50% of major and minor PIV complications occurs in the hand and wrist area! We can not ignore this any longer. Can you tell this is my soapbox!!
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Is there any difference between INS standards and JCAHO definitions of restraints? We have so much education about restraints and having physician orders for restraints.
I wonder if this is where the differnce in opinions about restraints are ......of the standards ..........or of patient safety goals apply.
Sorry if this seems to be a dumb question.
Gwen
NO, the Standards Committee used the JCAHO standards to write this standard. Anything to immobilize a joint for medical purposes is NOT considered to be a restraint. Look at the INS standards and look up the JCAHO reference. A handboard is not now, nor has it ever, been consider to be any form of a restraint!!
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I use armboards as necessary on our peds patients and do not consider them restraints but part of the securement of the PIV. Usually there is no restriction on movement of the extremity--they can be placed so that the wrist is immobilized but the fingers are loose so that the child can still grasp to color, eat, etc. I find that often a board is placed to immobilize more of the extremity than neccessary. And I never place boards on feet. I agree with Lynn and don't think there is anything else that can serve the same purpose.
As far as pulling NGs, TPs. etc out, hand mittens are effective for some kids. We just don't have a big problem with kids pulling out lines or anything else. It does happen but then we address it on an individual basis rather than assume all patients will act the same way.
I have this debate with people all the time. When I mention to nurses I am training that they must use an armboard to immobilize a joint when an IV is inserted at that point, they often act like I am suggesting a medieval torture device, and many of them claim that this is considered a restraint "in their state". Is there a state that legally defines an armboard or handboard as a restraint? How can I prove to those who are deluded that they are incorrect? I would need something to disprove their individual "state law" beliefs. -LA
I am not aware of any states that have any rules or regulations about this, but I could definitely be wrong. I would insist upon those people providing this information to me. In the meantime, I use this statement from JCAHO
"Restraint used for the protection of surgical and treatment sites in pediatric and adult patients are not considered restraint." This statement is taken from http://www.jointcommission.org/AccreditationPrograms/BehavioralHealthCare/Standards/FAQs/Provision+of+Care+Treatment+and+Services/Restraint+and+Seclusion/Restraint_Seclusion.htm and scroll to the end of that page.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861