- Patients should not be restrained unless it is medically necessary. Restraints must never be used to punish the patient or make things easier for staff.
- The patient’s family should be included in the care plan. They must be consulted before using restraints and informed about the facility’s restraint rules and other options.
- Physical restraints should only be used after carefully checking the patient, their surroundings, and the situation. Other methods to calm the patient must be tried first, and any triggers should be identified and removed, if possible. Experts should be consulted if needed.
- Restraints must only be used if less-restrictive methods have failed, and these efforts must be recorded.
- Any reasons that would make restraints unsafe for the patient must be considered.
- The benefits of using restraints must be greater than the risks for the patient.
- Restraints must be ordered by a doctor or licensed practitioner. Orders cannot be "as needed."
- Once restraints are applied, the patient must be checked regularly. Adults must be reassessed every 4 hours, children aged 9 to 17 every 2 hours, and children younger than 9 every hour.
- In medical-surgical settings, the doctor or licensed practitioner must evaluate the patient every 24 hours.
- The patient’s vital signs must be checked every 2 hours, and medical patients must also be observed visually.
- Patients must be cared for every 2 hours—this includes giving fluids, food, and help with toileting.
- The patient’s skin must be checked and movement exercises should be done every 2 hours.
- Detailed
notes must be kept about why restraints were used, how they were applied,
where they were placed, how long they were used, and how the patient was
monitored
The following R-E-S-T-R-A-I-N-T acronym prompts effective use of restraints (DiBartolo, 1998).
Respond to the present, not the past. The patient’s current condition, not his or her past history, must determine the need for restraints. This includes assessment of physical condition and mental and behavior status.
Evaluate the potential for injury. Determine whether the patient is at increased risk for harming self or others.
Speak with family members or caregivers. Ask them for insights into the patient’s behavior, and enlist their help in making a decision.
Try alternative measures first. Also, investigate the patient’s medication regimen and attempt to discuss options with the patient.
Reassess the patient to determine whether alternatives are successful. Agency policy dictates the frequency of assessments and documentation.
Alert the primary care provider and the patient’s family if restraints are indicated. It requires an order from a physician or other healthcare professional licensed to prescribe in the state. The order should include the type of restraint, justification, criteria for removal, and intended duration of use.
Individualize restraint use. Choose the least-restrictive device.
Note important information on the chart. Document the date and time the restraint is applied, the type of restraint, alternatives that were attempted and their results, and notification of the patient’s family and physician. Include frequency of assessment, your findings, regular intervals when the restraint is removed, and nursing interventions.
Time-limit the use of restraints. Release the patient from the restraint as soon as he or she is no longer a risk to self or others. Restraints should be used no longer than 24 hours on non-psychiatric patients. After 24 hours, a new order is required.
