Registered Nurses' Association of Ontario

Suggestions to Prevent or Limit the Use of Restraints

Presenting Behaviours

Examples of Suggested Alternatives

Falls

• Medication review

• Toileting regularly

• Quad exercise: mobility/ ambulation

• Routine positioning (Q2H)

• Increased participation in ADL

• Pain relief/comfort measures

• Normal schedule/individual routine

• Assess for hunger, pain, heat, cold

• Glasses, hearing aids, walking aids easily available

• Increase social interactions

• Redirect with simple commands

• Call bell demonstration

• Involve family in planning care

• Diversional activities: pets, music, puzzles, crafts, cards, snacks

• Scheduling daily naps

• Alarm devices- bed/chair/ door

• Clutter free rooms

• Mattress on floor/lower bed

• Non-slip strips on floor

• Night light

• Helmet

• Acceptance

Cognitive Impairment e.g. dementia

• Toileting regularly

• Normal schedule/individual routine

• Assess for hunger, pain, heat, cold

• Label environment i.e. bathroom door

• Increase social interactions

• Redirect with simple commands

• Gentle touch

• Assessing past coping strategies

• Involve family in planning care

• Diversional activities: pets, music, puzzles, crafts, cards, snacks

• Reminiscence

• Scheduling daily naps

• Pacing permitted

• Alarm devices- bed/chair/door

• Clutter free rooms

• Night light

• Glasses, hearing aids, walking aids easily available

Acute Confusion - delirium

• Medication review

• Work-Up for underlying cause- see Pre-Printed Orders

• Pain relief/comfort measures

• Glasses, hearing aids, walking aids easily available

• Toileting regularly-start q2h

• Normal schedule/individual routine

• Assess for hunger, pain, heat, cold

• Label environment i.e. bathroom door

• Increase/decrease social interactions

• Redirect with simple commands

• Gentle touch

• Assessing past coping strategies

• Involve family in planning care

• Scheduling daily naps

• Alarm devices- bed/chair/door

• Clutter free rooms

• Night light

Agitation

• Mobility/ambulation/exercise routine

• Routine positioning (Q2H)

• Medication review

• Pain relief/comfort measures

• Toileting regularly

• Normal schedule/individual routine

• Assess for hunger, pain, heat, cold

• Increase social interactions

• Redirect with simple commands

• Relaxation techniques (tapes, dark environment)

• Gentle touch

• Assessing past coping strategies

• Involve family in planning care

• Diversional activities: pets, music, puzzles, crafts, cards, snacks

• Scheduling daily naps

• Pacing permitted

Wandering

• Assess for hunger, pain, heat, cold

• Buddy system among staff/consistency

• Label environment i.e. bathroom door

• Increase social interactions

• Redirect with simple commands

• Assessing past coping strategies

• Involve family in planning care

• Diversional activities: pets, music, puzzles, crafts, cards, snacks

• Tape (stop) line on floor

• Alarm devices- bed/chair/door

• Clutter free rooms

• Night light

• Room close to nursing station

• Glasses, hearing aids, walking aids easily available

Sliding

• Consults to OT/PT

• Routine positioning (Q2H)

• Pain relief/comfort measures

• Call bell demonstration

• Wedge cushions/tilt wheelchairs (consult OT/ PT)

• Non slip cushion (consult OT)

Aggression

• Medication review

• Pain relief/comfort measures

• Assessing past coping strategies

• Normal schedule/individual routine

• Assess for hunger, pain, heat, cold

• Increase/decrease social interactions

• Relaxation techniques (tapes, quiet/dark room)

• Involve family in planning care

• Pacing permitted

• Soothing music

Pulling out invasives/tubes

• Pain relief/comfort measures

• Increase social interactions

• Redirect with simple commands

• Call bell demonstration

• Stimulation/meaningful distraction

• Explain procedures/treatments

• Gentle touch

• Involve family in planning care

• Camouflage tubing on IV

• Abdominal binder over PEG

• Change IV to intermittent asap

• Arm splint (prevent elbow bending)

Unsteadiness

• Mobility/ambulation/exercise

• Medication review

• Increase social interactions

• Call bell demonstration

• Scheduling daily naps

• Clutter free rooms

• Mattress on floor/lower bed

• Non-slip strips on floor

• Night light

• Acceptance of injuries

• Glasses, hearing aids, walking aids easily available

Clinical Management
Promoting Safety: Alternative Approaches to the Use of Restraints
Point of Care Resources