Application of mitts

The Walton Centre NHS Foundation Trust recognises that, at times, patients in our care may require hand control mitts. This leaflet contains information about mitts, what they are, why they are used and what having mitts in place means for patients.

What are mitts?
Hand control mitts are padded gloves, see below.

Why are mitts used?

Some patients have essential lines and tubes put in, such as a nasogastric (NG) tube (feeding tube in the nose), tracheostomy (to help with breathing) etc so that treatments can be given during their illness. Some of these treatments are critical to keep patients alive.

On occasion many patients who are very unwell experience delirium, restlessness, anxiety, and cognitive impairment. This is particularly common in the Intensive Care Unit or assessment and rehabilitation units. Through no fault of their own, patients may attempt to remove their lines and tubes, putting themselves at risk of harm. The clinical teams will have tried to calm and reassure the patient to see if this helps to keep their lines and tubes in place. However, if the patient is still very restless, we sometimes have to use mitts for a short time to stop them removing the lines or tubes and make sure they get the treatment they need.

Staff assess and review the need to use mitts every day. They must follow strict guidelines to ensure they are used correctly. The staff may decide to use mitts on what is known as a ‘best interest’ basis. This means that for patients who are not able to make decisions themselves, mitts are put on when it is felt that this is in their best interests.

Where possible, we will always try to involve patients, family members, carers or advocates (representatives of the patient) in these decisions. We will try and show them the mitts before they are used but, at times, for safety, they may be applied before your visit.

Before using mitts

We will try lots of other things before using mitts, including:

• Reassurance
• Explanation
• Orientation
• Involving friends and family
• Identifying other causes of distress, e.g. pain, constipation
• Staying with the patient
• Turning off lights, reducing noise
• Reducing stimulation

What are the benefits of using the mitts?

• Nutrition, hydration or medication tubes and lines remain in place which is vital for the patient
• They prevent the distress and discomfort of replacing tubes or lines that patients have removed

What happens when patients are wearing mitts?

When the mitts are used, they are removed regularly to check that patients’ hands and the skin underneath are not being harmed by the mitts. This may be timed around family and carer visits so that they can be removed during a visit.

What are the side effects of using the mitts?

If the mitts are put on too tightly, this may damage the skin. Ward staff check patients on a regular basis in order to prevent this.

How can friends and family help?

Please be reassured that this phase is normally short and most patients do not go on to have long-term problems with agitation; and in fact most do not remember it at all. Although having someone familiar at the bedside can be calming for the patient, it is also really important that you take time away to rest.

You can help by:

• Being with the patient
• Holding their hand
• Talking to them
• Completing a patient profile with the clinical team

When are mitts not used?

We don’t use mitts if the patient is violent, as from experience we know they do not help. At these times it might be necessary to administer fast-acting medicines to keep the patient and others safe.

Can I find out more?

If you have any concerns about the mitts being used, or would like to discuss them, please speak to the nurse in charge of the ward.