Alternatives to
Restraints/Restraints
Workshop
Definitions
What is a restraint?
– A restraint can either be physical or
chemical and is used to limit activity or to
control an individual’s behavior.
Alternatives to Restraint
Patients have the right to control their own
body and their actions.
But What Happens When They Become A
Risk To Themselves And Others?
Alternatives to Restraint
The First Step one must consider before
physical or chemical restraints are applied /
administered depends on:
– Is the patient demonstrating disruptive
behavior because they are
–Frustrated
–Anxious
–Bored
–Confused
Alternatives to Restraint
If you can answer “yes” to any of those
questions, consider ways to alter or
change the patient’s environment.
– Walking
– Exercise
– Reduce noise level to allow the patient to sleep
and to reduce their agitation.
– Turn the TV off.
– Use bed/chair check
– Use family members; get sitters
Alternatives to Restraint
Why are alternatives to restraints so important?
– Patients become weaker with immobilization.
– Restraint devices increase agitation.
– Patients who are restrained are at a greater risk
of falling and sustaining more serious injuries if
they do fall.
– Psychological side effects can include feelings of
anger, loss of dignity and depression.
Smith, N., Timms, J., Parker, V., Reimels, E., Hamlin, A. (2003). “The impact of education on the use of physical
restrains in the acute care setting.” The Journal of Continuing Education in Nursing. 34(1): 26-33.
Alternatives to Restraint
What is the difference between…
Acute Medical / Surgical Restraints
&
Behavioral Health Restraints
Medical / Surgical Restraint
Rule of thumb…
If the patient is at risk for
interruption of the medical treatment
plan, such as pulling out tubes with
agitation, he or she meets the
criteria for a Medical / Surgical
Restraint
Behavioral Health Restraint
Rule of thumb…
A patient who is at risk for imminent harm
to either himself or someone else due to
violent behavior, he meets the criteria for
a Behavioral Health Restraint.
Case Scenario
What category of restraint would be used
for this situation…
A female patient returns from surgery and is
confused and attempting to pull out her IV
and foley catheter. After alternative methods
of redirecting her from pulling out her lines
have failed, which criteria for restraint would
this patient fall under?
Case Scenario
What category of restraint would be used
for this situation…
A male patient is admitted with an elevated
blood alcohol level. He is admitted to your
unit with IV therapy running. He attempts to
pull out his line. When you try to redirect
him, he verbally threatens you and tries to
kick you away from his bed with a purposeful
aim, which criteria for restraint would this
patient fall under?
Alternatives to Restraint
The following products are alternatives to restraints
Disposable Freedom Splint
(alternative to limb holder)
(SDS)
Alternatives to Restraint
The following products are alternatives to restraints
Self Releasing Lap Hugger
(Unit Purchase)
Alternatives to Restraint
The following products are alternatives to restraints

Wedge Foam Cushion
(Unit Purchase)
Alternatives to Restraint
The following products are alternatives to restraints
Bedfellow Positioning Roll
(Unit Purchase)
cover with a sheet*
Alternatives to Restraint
The following products are alternatives to restraints
Peek a Boo Mitts (SDS)
Types of Restraints
If All Else Fails…
Remember that the care of the patient while he or she is
in the restraint is part of a process that requires the
health care team to provide quality care. This care is
measured by careful documentation!
Types of Restraints
– Disposable quick release limb restraint
– Side Rails
– Locked restraint
Performance Improvement
•
•
Documentation
Patient Care
Safety Concerns
Physicians order must be obtained
within one hour of initiation of
restraints.
Safety Concerns
Documentation should include:
– The need for restraints
– The alternatives that were applied to avoid
restraint usage
– Notification of Family
– Time the restraint was initiated or
discontinued
– The type of restraint in use
Safety Concerns
Documentation should include:
– That observation and patient care needs /
assessments were met
– The patient’s behavior while in restraints
– Ongoing communication with the patient and
their family concerning the termination of
restraint measures
Assessment / Care
of the Patient in Restraints
Restraints for Medical Reasons…
– Monitor and Observation of Patients every 2 hours.
– Observation includes:
• Respiratory Status
• Circulation
• Signs of Distress
• Change in Behavior
– Patient Care every two hours and prn includes:
• Comfort measures
• Fluid and nutritional needs
• Toileting needs
• Check circulation of restrained limbs
• Range of Motion and Repositioning
– Continue to try alternatives and to eliminate the cause for the use of
restraints.
– Reassessment / MD Order daily and prn
– Ongoing patient / family teaching related to criteria for removal of
restraints.
Assessment / Care
of the Patient in Restraints
Restraints for Behavioral Management…
–
–
–
–
–
Patient will be placed on 1:1 observation
Examine Patient and room for contraband
Order a “disposable tray” for patient meals
Modify treatment plans with interventions to eliminate the restraints.
Reassessment under direction of RN every 15 minutes
• Observation and Assessment
• Patient Care Assessment and Needs
– Continue to try alternatives to eliminate the cause for the use of
the restraints.
– Reassessment for the need for restraints:
• By RN every 4 hours ( 2 hours for adolescents)
• By MD every 8 hours (4 hours for adolescents)
Questions?