PPE during restraints

How are facilities handling staff using PPE/surgical masks during physical restraints and applying restraints? Does each staff member get a mask or is it handled a different way? We are trying to weigh risk/benefit against using the supply of masks that may be needed later when treating sick patients.

Comments

  • How are you handling giving patients with COVID symptoms medications? Oral vs. injectables? What if you are low on mask supplies?

  • We are still providing injectables where possible. Consider adding cloth masks to your supply - can put a surgical mask inside to protect and extend length it is good. If patient is able to be maintained effectively on oral, then we are considering it.

  • Based on a review of restraint/seclusion policy, and restraint records for 4 patients, Patient #10 received an incomplete restraint order, disparate documentation of the number of points used during the restraint, and no assessments during the 2-hour restraint, and Patient #12 had a personal protection equipment (PPE) mask applied to his face during restraint.

    The hospital Patient Restraint and Seclusion policy (revised 2/13) states in part for Behavioral restraints "Assessment and monitoring by the nurse of the following every 15 minutes, at a minimum: a. circulation checks; b. respiration checks; body alignment; d. hydration and nutritional needs, e. elimination needs, f. skin integrity, g. mental status; h. appropriateness of continuing restraints." The policy does not address the use of a PPE mask as a spit mask, nor does it address the use of spit mask design for that purpose.

    The incubation period for COVID-19 is thought to extend to 14 days, with a median time of 4-5 days from exposure to symptoms onset.1-3 One study reported that 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection.3

    Presentation
    The signs and symptoms of COVID-19 present at illness onset vary, but over the course of the disease, most persons with COVID-19 will experience the following1,4-9:

    Fever or chills
    Cough
    Shortness of breath or difficulty breathing
    Fatigue
    Muscle or body aches
    Headache
    New loss of taste or smell
    Sore throat
    Congestion or runny nose
    Nausea or vomiting
    Diarrhea
    Symptoms differ with severity of disease. For example, fever, cough, and shortness of breath are more commonly reported among people who are hospitalized with COVID-19 than among those with milder disease (non-hospitalized patients). Atypical presentations occur often, and older adults and persons with medical comorbidities may have delayed presentation of fever and respiratory symptoms.

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