A nurse is reinforcing teaching about toilet training with the guardians of a toddler who has a cognitive impairment. Which of the following instructions should the nurse include?

A. Contacting the provider within 48 hr is incorrect. A prescription for restraints must be obtained within 1 hour of applying restraints, not within 48 hours. The nurse should ensure that this prescription is obtained promptly.

B. Removing the restraints every 2 hr is correct. The nurse should remove the restraints every 2 hours to assess the skin, provide range-of-motion exercises, and offer comfort. This ensures that the client is not harmed from prolonged restraint use.

C. Checking that one finger fits between the client's wrists and the restraints is incorrect. The nurse should ensure that the restraints are snug but not too tight to cause injury, typically allowing for two fingers of space, not just one.

D. Fastening the restraints' ties to the bed's side rails is incorrect. Restraints should be fastened to a movable part of the bed frame (not side rails) to prevent injury or accidental strangulation. The side rails can move and cause undue tension on the restraints.

A. "Define the problem.": While defining the problem is important in the early stages of performance improvement, evaluating effectiveness requires looking at data or outcomes, not just the initial identification of the issue.

B. "Identify data collection methods.": Identifying data collection methods is part of the planning phase, but evaluating the effectiveness involves reviewing actual data to see if the goals of the program were achieved.

C. "Perform chart audits.": This is correct. Performing chart audits allows the nurse to assess if the desired improvements have been implemented and whether the performance outcomes are being met. Chart audits are a common method for evaluating the effectiveness of a performance improvement program.

D. "Review the facility's policy and procedure manual.": While reviewing policies is important for understanding standards of care, it does not directly evaluate the effectiveness of a performance improvement program. Data from actual practice, such as chart audits, would be more relevant for evaluation.