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Use of restraints

Restraint devices

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.

There are many types of restraints. They can include:

• Belts, vests, jackets, and mitts for the patient's hands
• Devices that prevent people from being able to move their elbows, knees, wrists, and ankles

Other ways to restrain a patient include:

• A caregiver holding a patient in a way that restricts the person's movement
• Patients being given medicines against their will to restrict their movement
• Placing a patient in a room alone, from which the person is not free to leave

When are Restraints Used?

Restraints may be used to keep a person in the 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:

• Scratch their skin
• Remove catheters and tubes that give them medicine and fluids
• Get out of bed, fall, and hurt themselves
• Harm other people

Patient Rights

Restraints 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:

• Limit only the movements that may cause harm to the patient or caregiver
• Be removed as soon as the patient and the caregiver are safe

In a hospital, a nurse who has special training in using restraints can begin to use them. A provider must also be told restraints are being used. The provider must then sign a form to allow the continued use of restraints.

Patients who are restrained need special care to make sure they:

• Can have a bowel movement or urinate when they need to, using either a bedpan or toilet
• Are kept clean
• Get the food and fluids they need
• Are as comfortable as possible
• Do not injure themselves

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.

References

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.

Moore MJ, Heiner JD. The combative and difficult patient. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 185.

The Joint Commission website. Restraint and seclusion - enclosure beds, side rails and mitts. www.jointcommission.org/standards/standard-faqs/nursing-care-center/provision-of-care-treatment-and-services-pc/000001668/. Updated July 20, 2022. Accessed October 27, 2023.

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Review Date: 10/13/2023  

Reviewed By: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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