Restraints in a medical setting are devices that limit a patient's movement. Restraints can help keep a person from getting hurt or doing harm to others, including their caregivers. They are used as a last resort. Show
There are many types of restraints. They can include:
Other ways to restrain a patient include:
When are Restraints Used?Restraints may be used to keep a person in proper position and prevent movement or falling during surgery or while on a stretcher. Restraints can also be used to control or prevent harmful behavior. Sometimes hospital patients who are confused need restraints so that they do not:
Patient RightsRestraints should not cause harm or be used as punishment. Health care providers should first try other methods to control a patient and ensure safety. Restraints should be used only as a last resort. Caregivers in a hospital can use restraints in emergencies or when they are needed for medical care. When restraints are used, they must:
A nurse who has special training in using restraints can begin to use them. A doctor or another provider must also be told restraints are being used. The doctor or other provider must then sign a form to allow the continued use of restraints. Patients who are restrained need special care to make sure they:
Patients who are restrained also need to have their blood flow checked to make sure the restraints are not cutting off their blood flow. They also need to be watched carefully so that the restraints can be removed as soon as the situation is safe. If you are not happy with how a loved one is being restrained, talk with someone on the medical team. Restraint use is regulated by national and state agencies. If you want to find out more about restraints, contact The Joint Commission at www.jointcommission.org. This agency oversees how hospitals are run in the United States. Alternative NamesRestraint devices ReferencesHeiner JD, Moore GP. The combative and difficult patient. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 189. Kowalski JM. Physical and chemical restraint. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 69. Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Body Safe client environment and restraints. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 7. The Joint Commission website. The comprehensive accreditation manual for hospitals. www.jointcommission.org/accreditation/hospitals.aspx. Accessed October 24, 2021. Review Date 10/24/2021Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of use of restraints and safety devices in order to:
The most common reasons for restraints in health care agencies are to prevent falls, to prevent injury to self and/or others and to protect medically necessary tubes and catheters such as an intravenous line and a tracheostomy tube, for example. All health care environments adopt the philosophy and goal of a restraint free environment; however, it is not often possible to prevent the use of restraints and seclusion. There are rare occasions when the use of restraints is not preventable because the restraints have become the last resort to protect the client and others from severe injuries. Commonly Used Terms Associated With Restraints and Restraint Use
For example, a vest restraint to prevent a patient fall is an example of a physical restraint and a sedating medication to control disruptive behavior is considered a chemical restraint. Both restrict the person's ability to move about freely. Other examples of physical restraints are soft padded wrist restraints, a sheet tied around a person to keep them from falling out of a chair, side rails that are used to stop a person from getting out of bed, a mitten to stop a person from pulling on their intravenous line, arm and leg restraints, shackles, and leather restraints.
Assessing the Appropriateness of the Type of Restraint UsedNurses assess and determine the need for a client to be restrained or secluded and they also assess the appropriateness of the type of restraint/safety device that is used in context with the client's current condition and behaviors; they assess and reassess the client in a regular and ongoing basis to insure that the client is safe and that their needs have been met when the use of restraints or seclusion cannot be avoided. These assessments also explore the client's condition within the context of the appropriateness of the restraint in terms of its being the least restrictive alternative and being used for the shortest possible period of time. Following the Requirements For the Use of Restraints and Safety DevicesAccording to the Joint Commission on the Accreditation of Health care Organizations and the Centers for Medicare and Medicaid Services, there are many regulations and requirements that address restraints and restraint use including:
Alternative Preventive MeasuresSome of the preventive, alternative measures that can decrease the need for restraints to prevent a fall include:
Some of the preventive, alternative measures that can decrease the need for restraints in order to prevent the dislodgment of medical tubes, lines and catheters include:
Some of the preventive, alternative measures that can decrease the need for restraints in order to prevent violent behaviors that place self and/or others at risk for imminent harm include:
Restraint OrdersA complete doctor's order is needed to initiate the use of restraints except under extreme emergency situations when a registered nurse can initiate the emergency use of restraints using an established protocol until the doctor's order is obtained and/or the dangerous behaviors no longer exist. Restraints without a valid and complete order are considered false imprisonment. The minimal components of orders for restraint include the reason for and rationale for the use of the restraint, the type of restraint to be used, how long the restraint can be used, the client behaviors that necessitated the use of the restraints, and any special instructions beyond and above those required by the facility's policies and procedures. The Least Restrictive RestraintThe least restrictive restraint to correct the problem like falls and the dislodgment of tubes, lines and catheters is used when restraints are necessary. Restraints, from the least restrictive to the most restrictive, are:
Restraints should NEVER be used for staff convenience or client punishment. Monitoring the Client During RestraintWhen you monitor the patient or resident who is restrained, you must observe and monitor the patient's physical condition, the patient's emotional state, and the patient's responses to the restraint or seclusion. Is the patient safe? Are the restraints still in place and safely applied? Are the patient's vital signs normal? Are the skin color, intactness of the skin, and circulation good? Is the restraint too tight? Is the patient comfortable and without any physical needs that you can attend to like toileting, food and/or fluids? Is the person confused? Is the patient or resident angry, upset or agitated? Is the person afraid or fearful? After the restraint is applied, initial monitoring is done whenever necessary but at least every 15 minutes for the first hour by a licensed independent practitioner (LIP) or the qualified registered nurse (RN). When the patient or resident is stable and without significant changes, the monitoring and correlate documentation is then done at least every 4 hours for adults, every 2 hours for children from 9 to 17 years of age, and at least every hour for those less than 9 years of age. The scope of monitoring must include an evaluation or reassessment of the patient's:
The Provision of Care to Restrained ClientsThe following aspects of care must be provided as needed to a restrained patient or resident and documented at least every two (2) hours when the person is restrained for non behavioral reasons, and at least every four (4) hours when the person is restrained for behavioral reasons and more often for children (every two (2) hours for those 9 to 17 years of age, and at least every hour for those less than 9 years of age, unless the person needs more frequent care. The components of this care are based on the client's needs and it typically includes:
Some facilities use restraint flow sheets to document and record the use of restraints, the monitoring of the client, the care provided and the responses of the patient who is restrained or in seclusion. When these flow sheets are not used, the nurse must document all monitoring and care elements in the progress notes. Monitoring and Evaluating Client Response to Restraints and Safety DevicesWhen the registered nurse monitors and evaluates the client's responses to the restraints or safety device, the nurse will assess and evaluate the client and their:
Trial releases from restraints and attempts to control the behavior with appropriate alternatives to restraint provides the registered nurse and/or licensed independent practitioner (LIP) with reassessment data that guides the decision-making process in terms of the: |