Nobody wants to see a loved one put in restraints under any circumstances. Not only is it difficult for the individual and their family, but also for the healthcare providers involved. In healthcare facilities, the use of restraints is never a first line remedy and is only implemented to maintain patient safety when a patient is violent, has self-destructive behavior or other behavior that interferes with medical treatment. For example, confusion, agitation or delirium in hospitalized patients may cause an individual to pull out IV lines, take off telemetry leads, remove oxygen-delivering equipment or even dislodge urinary catheters. This is counterproductive to recovery.
If alternatives have been attempted and a restraint is necessary, there are 3 different categories of restraints: physical, chemical and seclusion. A physical restraint is a device or intervention that prevents a patient from moving freely. It is the most common form of restraint and includes applying hand mitts and wrist, ankle, chest or lap restraints. It also includes keeping all side rails up to prevent a patient from getting out of bed, tucking in linens tightly to restrict movement and even use of an enclosure bed.
 |  |  |
A chemical restraint is when a drug is administered to restrict a patient’s movement or behavior where the drug or dosage isn’t an approved standard of treatment for the patient’s condition. For example, the antipsychotic drug Haloperidol (haldol) is commonly used to manage delirium-associated agitation in hospitalized patients. It is also a widely accepted practice to administer a benzodiazepine, such as Ativan, for a patient with alcohol-withdrawal delirium. However, utilizing one of these drugs for another type of reason, to create a sedating effect, may not be appropriate.
Lastly, seclusion is a form of restraint typically only utilized by emergency departments or psychiatric facilities where a violent individual is placed in a special seclusion room to prevent them from leaving the facility before proper care may be provided.
Lastly, seclusion is a form of restraint typically only utilized by emergency departments or psychiatric facilities where a violent individual is placed in a special seclusion room to prevent them from leaving the facility before proper care may be provided.
Regardless of the type of restraint being utilized, it is considered a high-risk intervention by the Centers for Medicare and Medicaid Services and The Joint Commission. Restraints should never to be used for coercion, punishment, discipline or convenience. Restraints can cause serious injury and The Joint Commission as a result considers any death that may occur a sentinel event.
Regulation requires proper assessment, intervention and documentation. For example, ongoing nursing assessment of patient status, including frequent vital signs and skin assessment, along with reevaluation of need for restraint, is required while any restraint is in place. Additionally, a physician assessment and written order is also required for application of a restraint and must be renewed every 24 hours. Any healthcare facility will have specific policies outlining safe practices for restraint utilization.
Regulation requires proper assessment, intervention and documentation. For example, ongoing nursing assessment of patient status, including frequent vital signs and skin assessment, along with reevaluation of need for restraint, is required while any restraint is in place. Additionally, a physician assessment and written order is also required for application of a restraint and must be renewed every 24 hours. Any healthcare facility will have specific policies outlining safe practices for restraint utilization.
RSS Feed