Medical Restraints
Purpose
• Medical Surgical restraints should be used
to create a physical and cultural
environment promoting comfort, safety, and
the security of patients and others.
• Restraints should never be used for
punishment, or the convenience of staff or
other individuals, or as a substitute for
effective treatment.
Intent for Restraints
• Utilize alternative to restraints – less
invasive, and less restrictive measure
• Limit the use of restraints - to assist in the
care of the patient and protect the health and
safety of the patient
• Document assessments, efforts, and care
• Assure the patients rights are preserved at
all times
Definitions
• Physical Restraint Standard – The direct
application of physical force to a patient
with or without the patient’s permission to
restrict his/her freedom of movement. The
physical force may be human, mechanical
devices or combination thereof. (JCAHO)
Definitions
• Restraint – Any method (chemical or physical) of
restricting a patient's freedom of movement,
including seclusion, physical activity, or normal
access to his or her body that (1) is not a usual and
customary part of a medical diagnostic or
treatment procedure to which the patient or his or
her legal representative has consented; (2) is not
indicated to treat the patient’s medical condition or
symptoms; or (3) does not promote the patient’s
independent functioning. (JCAHO)
Definitions
• Alternative to restraints
– Allow for a patient’s behavior without
restriction of movement
• Forensic and correctional restraints
– Forensic staff will be responsible for the
initiative and release of restraints for
individuals requiring law enforcement restraint
Definitions
• Emergency situations
– All measures must be taken to protect the
patient from bodily injury to themselves and
others
When to Use Restraints
• The decision to use restraints is driven not
by diagnosis, but by comprehensive
individual assessment that concludes that
for this patient, at this time, the use of less
intrusive measures pose a great risk than the
risk of using a restraint. (HCFA- Hospital
Conditions of Participation for Patients’
Rights)
Alternatives to Restraints
• Alternative methods
– Diversional activities – TV, radio, reading, games,
ambulation
– Provide information to alleviate fear
– Interaction by family member, child life or volunteers
– Collaborate with medical staff to change treatment plan
if indicated
– Environmental changes – reduce noise, call light with
in reach, change lighting within room
Alternatives to Restraints
• Alternative methods
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Include patient and parents in treatment plan
Move patient close to nurses station
Explain all procedures to alleviate fear
Provide reality orientation
Use relaxation techniques
Restraints do not Include
• Adaptive support
– Devices used to modify the environment to assist in the
individual’s care
• Protection of Therapeutic Devices
– All techniques used to protect therapeutic devices such
as IV, endotrachial tubes
• Treatment plan
– All devices used to reduce movement during a
procedures – medical, dental, diagnostic, or surgical
Criteria for Restraint
• Physician order required
• Assessment of patient to determine the
clinical need
– Cognitive deficiency
– Patient interfering with treatment
Physician Order Must Include
• Reason for restraint
– Combative, self harm, injury to others
• Type of restraint
– Vest, Ankle, or Wrist
• Date, time, and maximum length of time
– PRN orders are NOT allowed
Physician Order
• Verbal order can be obtained if the
physician is not readily available
• Licensed Independent Practitioner (LIP)
must sign, time, and date the order within
24 hours of time order is issued
• New order is required if restraint is off
greater than 24 hours
Protect the Patient’s Rights
• The rights of the individual
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Right to privacy
Personal dignity
Well being
Protection from psychological harm
must be preserved during the use of
restraints.
Monitor – Document
at least every 2 hours
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Circulation
Skin color
Respiration
Fluids
Nourishment
Toileting
• Range of motion – at
least 5 minutes for
every hour in
restraints
• Mental status
• Behavior
Termination of Restraints
• Restraints may be removed after the
physician or the RN assesses the patient and
determines that the criteria for removal has
been met.