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Difficulty: HardSafe Use of Restraints and Safety Devices

The registered nurse receives the shift report for four clients on a medical-surgical unit. Which client situation regarding the use of safety devices requires the nurse's immediate intervention?

  1. A client with bilateral soft wrist restraints who has a healthcare provider prescription written as "apply PRN (as needed) for severe agitation."Answer
  2. B
    A client with a mitten restraint applied to prevent pulling at an intravenous line, whose prescription was renewed 22 hours ago.
  3. C
    A client with bilateral soft wrist restraints whose last documented release for skin assessment and range of motion (ROM) exercises was 90 minutes ago.
  4. D
    A client with ankle restraints whose straps are secured to the movable portion of the bed frame using quick-release knots.

Answer

The client with a PRN (as needed) prescription for physical restraints requires immediate intervention.
According to regulatory guidelines (such as the Joint Commission and CMS), 'PRN' or 'as needed' prescriptions for physical restraints are explicitly prohibited. A restraint prescription must be for a specific, ongoing episode of care, and the provider must perform a face-to-face evaluation. The nurse must immediately intervene to clarify this invalid prescription and remove the restraints if a valid order is not obtained.

Step-by-Step Solution

1
Evaluate the legality of the restraint prescription for the first client.
Identify that a PRN order for restraints is illegal and unsafe.
Regulatory agencies prohibit PRN restraint orders to ensure restraints are only used for specific, ongoing episodes requiring strict monitoring.
2
Analyze the time elapsed since the mitten restraint prescription renewal.
Determine that 22 hours is acceptable.
Non-violent (medical-surgical) restraints require a new provider prescription every 24 hours.
3
Assess the interval since the last restraint release and ROM exercises.
Determine that 90 minutes is within safe limits.
Restraints must be released at least every 2 hours to prevent skin breakdown and maintain joint mobility.
4
Review the application method of the ankle restraints.
Determine that securing to the movable frame with quick-release knots is correct.
This method prevents injury during bed adjustments and allows rapid removal in an emergency.
5
Prioritize the most critical safety violation.
The PRN prescription is the priority.
An illegal restraint order is an immediate patient safety and legal risk.

Key Concept

Legal requirements and safe application protocols for physical restraints.
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Topics

Safe Use of Restraints and Safety Devices

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