Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Alternate Approaches List

Least Restraint Last Resort Policy

Examples/suggested alternatives and patient behaviours

Presenting Behaviour: Falls

Examples of Suggested Alternatives

  • 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 of risk

Presenting Behaviour: Cognitive Impairment- eg. dementia

Examples of Suggested Alternatives

  • Toileting regularly
  • Normal schedule/ individual routine
  • Assess for hunger, pain, heat, cold
  • Label environment ie 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

Presenting Behaviour: Acute Confusion- delirium

Examples of Suggested Alternatives

  • 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 ie 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

Presenting Behaviour: Agitation

Examples of Suggested Alternatives

  • 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

Presenting Behaviour: Wandering

Examples of Suggested Alternatives

  • Assess for hunger, pain, heat, cold
  • Buddy system among staff/ consistency
  • Label environment ie 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

Presenting Behaviour: Sliding

Examples of Suggested Alternatives

  • 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)

Presenting Behaviour: Agression

Examples of Suggested Alternatives

  • 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

Presenting Behaviour: Pulling out invasives / tubes

Examples of Suggested Alternatives

  • 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)

Presenting Behaviour: Unsteadiness

Examples of Suggested Alternatives

  • 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

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