RestraintRestraint--Free Free Dementia Care

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					Restraint-
Restraint-Free
Dementia Care

  Amelia Schafer, MS
  Education Director
Alzheimer’s Association
Patient and Resident Safety
  Why focus on dementia?

5.3 million Americans have
Alzheimer’s disease (AD)
Every 70 seconds someone
develops AD
Communication deficits
Confusion and fear
Sensitive to changes
    Why are restraints used in
         dementia care?
Hospital
 – Interfering with treatment (pulling tubes, etc.)
 – Falls
 – Wandering & liability
Nursing Home
 – Falls
 – Wandering
 – Behaviors
      Why restraint free care?

1)   Reduces safety in many cases
2)   Physical consequences
3)   Psychological consequences
4)   Regulations
What do patients/residents say?
          “It must be for my
          own good.”

                          “Maybe I would
                           fall without it.”


                “I feel like a
                    prisoner.”
“What if there was a
fire? I couldn’t get
out.”

“Why are they
punishing me?”


            “I can’t get to the
            toilet at night and I
            wet my bed.”
                        Restraint-
              Promoting Restraint-Free Care, Foundations of
              Dementia Care, Alzheimer’s Association, 2007
                How do we begin?
Root cause analysis
  Why, where and when are people…..
   – Falling
   – Pulling tubes
   – Hitting caregivers
   – Wandering away
*Sample behavior log
  *http://www.nursing.upenn.edu/centers/hcgne/gero_tips/PDF_files/Behavior_Log.pdf
           Unmet needs
Hungry
Thirsty
Bathroom
Fear
Boredom
Comfort
      Why do people fall?
Dementia impairs judgement
People can’t remember they might fall
Hallucinations/delusions/paranoia
Disoriented to time and place
Balance problems due to dementia
Common in late stages of dementia
What else?
     Alternatives to Restraints
Falls protocol:   color coded wristband, alert all staff, other
common reasons for falling
Anticipate needs
Maintain physical function
Change environment
 – Bed
 – Lighting
 – Non skid mat
Movement devices
 – Use ones that alert nurses only
    Why do people wander?
70% of people with dementia wander
“I need to get home to cook for my children.”
Hallucinations/delusions/paranoia
Environment: too noisy, too busy
Boredom
Pain makes people restless
Everything is unfamiliar
What else?
        Alternatives to Restraints
Alert all staff, have wandering response protocol
Wanderguard, HUGS wristband to lock doors
 Put direction signs in room for bathroom, water, etc.
Put familiar items in room: pillow, picture, comfort item
Skilled dementia pain assessment
http://consultgerirn.org/uploads/File/trythis/assessingPain.pdf

Ask families/caregivers if they have wandered before
Be vigilant and aware at shift changes
Remove physical cues to “leave”
Keep light on in bathroom
Know their usual patterns (up at night for snack?)
 Behaviors and Dementia

          Behaviors

      *Are reactions to stimuli
  *Are a form of communication
*Will get worse until needs are met
 *Require individualized approach
        Behavior Examples
Person is pulling out their IV
1) Root cause analysis
2) Knowledge of dementia
3) Knowledge of person
4) Possible solutions:
Arm sleeve, keep hands busy, anchor tubes,
   offer sensory stimulation, substitute
   other treatment
         Behavior Examples
Person is sliding out of wheelchair
1) Root cause analysis
2) Knowledge of dementia
3) Knowledge of person
4) Possible solutions:
Involve OT/PT, change equipment, limit
   time in wheelchair, time of day, check
   for fatigue and pain, support whole body
Other examples?
     Restraint-
     Restraint-free dementia care
              Resources
Alzheimer’s Association Campaign for Quality Residential Care
http://www.alz.org/professionals_and_researchers_dementia_care_practice
_recommendations.asp
Hospitalization and dementia
http://www.nia.nih.gov/NR/rdonlyres/06518FF6-E68A-4C69-A915-
http://www.nia.nih.gov/NR/rdonlyres/06518FF6-E68A-4C69-A915-
7BCE0D738E0F/0/AcuteHospitalization707.pdf
Colorado Foundation for Medical Care
http://www.cfmc.org/nh/nh_restraint.htm
Hartford Institute for Geriatric Nursing http://www.hartfordign.org/
Falls, Wandering, and Physical Restraints: Interventions for residents in
assisted living and nursing homes,
http://www.alz.org/national/documents/Fallsrestraints_litereview_II.pdf
   Thank you!

  Amelia Schafer, MS
  Education Director
Alzheimer’s Association
    303-813-
    303-813-1669
Amelia.schafer@alz.org

				
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