Alternatives to Physical Restraints in Patients with Delirium and Dementia with Video

I recommend this video for alternatives to physical restraints even though it runs a little long (most videos from this source do). You can also find this and other videos at the link on the right side of this page labeled “Geriatric nurse resources” and that link takes you to the Hartford Institute for Geriatric Nursing–great resource. Our delirium project is working on edits for the delirium order sets and the nurse representative mentioned adding something about alternatives to restraints since they are often associated with delirium.

It’s amazing to me how often I see patients in physical restraints on the medical wards, especially the intensive care units. We even have different names for restraints: “medical restraints” or “behavioral restraints”. Distinguishing between the two, even on the video, sometimes sounds a little difficult. We also use bed alarms and “hi-lo” beds at our hospital.Sometimes you just have to use restraints for the patient’s safety and this video acknowledges that.

I’m not so sure about the Tramadol recommendation for pain management. I’ve seen plenty of patients, whether elderly and demented or not, made delirious by Tramadol alone or in combination with other serotonergic medications they may be taking, including antidepressants. I like the caution against anticholinergic medications, which can raise the risk for delirium.

Although the video is designed mainly for nurses, physicians and other allied health professionals involved in direct patient care can learn from it. This helps immensely in promoting a team-based approach. The other point I want to make about this and the other videos from this web site is the thorough attention to interdisciplinary team approaches to management, patient-focused individualized treatment, and clear communication with family members.


Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.