Restraint Application

Definition
Restraint application is a technique of physically restricting a person’s freedom of movement, physical activity or normal access to his body. A physical restraint is a piece of equipment or device that restricts a patient’s ability to move. It is any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body.
The definition of restraint is based not on the equipment or device but rather on the functional status of the client. If the client cannot release himself from the device physically, then the said device is considered a restraint.
Purpose of Restraint Application
Restraints are used to control a patient who is at risk of harming him or her self and/or others. In some cases, restraints are also used for children who are not capable of remaining still when they are frightened or in pain during administration of medication or performing other procedures. However, using restraints in any health care facility should be used as the last option in dealing with patients.
When to use restraints?
Physical restraint should be used only when other, less restrictive, measures prove ineffective in protecting the patient and others from harm.
Types of Restraints
  1. Soft restraints. This type of physical restraint device is used to limit movement of patients who are confused, disoriented or combative. The main goal of using this restraint is to prevent the patient from injuring him or her self and/or others.
  2. Vest and Belt Restraints. In using this device full movement of arms and legs are permitted. This is used to prevent the patient from falling from bed or a chair.
  3. Limb Restraints. Patients who are removing supportive equipments such as I.V. lines, indwelling catheters, NGTs and etc. are placed on limb restraints. This device allows only slight limb motion.
  4. Mitts. This device prevents the patient from removing supportive equipment, scratching rashes or sores and injuring him or herself and/or others.
  5. Body restraints. When patients become combative and hysterical they can be controlled by applying body restraints. This immobilizes almost all of the body.
  6. Leather Restraints. This restraint is only used when soft restraints are not sufficient to control the patient and when sedation is either dangerous to the patient or ineffective.
Precautions of Restraint Application
  1. Before applying restraints it is important to try other methods of promoting patient safety. Alternative methods that might be effective are reorientation of the patient to the physical surroundings, moving the patient’s room near to the staff members, teaching relaxation techniques in order to decrease anxiety and fear and decrease overstimulation.
  2. Documentation of any alternative method used is extremely important. Restraint application should be documented thoroughly.\
Situations that Requires Restraint Application
  1. Confused client tries to endanger him or herself
  2. Confused client attempts to remove supportive equipments such as necessary tubes, IV lines or protective dressings.
  3. The client is at risk for falls.
  4. The client is suicidal.
  5. The client poses harm or threat of inflicting harm to health care staff, other clients and/or visitors.
  6. A child is unable to remain still during a minor surgical procedure.
Equipments
Soft restraints
  • Vest restraint
  • Limb restraint
  • Mitt restraint
  • Belt restraint
  • Body restraint as needed
  • Padding if needed (large gauze pads can be used)
  • Restrain flow sheet (washcloth can be used)
Leather restraints
  • Two wrist and two ankle leather restraints
  • Four straps
  • Key
  • Large gauze pads – this is used to cushion each extremity
  • Restraint flow sheet (washcloth can be used)
Restraint Application Key Steps
  1. Make sure that the restraints are correct size for the patient’s build and weight.
  2. Explain the need for restraint to the patient. Assure him or her that they are used to protect him from injury rather than to punish him. It is necessary to inform the patient of the conditions necessary to release him or her from restraints.
  3. Restraints are ONLY used when all other methods have failed to keep the patient from harming himself or others. Restraints used should be least restrictive to the patient.
  4. Obtain adequate assistance to manually restrain the patient.
  5. After an hour of placing a restraint, the patient should be evaluated by a licensed independent practitioner and an order must be written for restraints.
  6. The order must ne time limited: 4 hours for adults; 2 hours for patients ages 9 to 17 years old; 1 hour for patients younger than 9 years old.
  7. The original order expires in 24 hours. Thus, the same order cannot be used the following day.
  8. To promote safety and ensure the patient is not harmed with restraint application, the patient should be assessed every 2 hours or according to the facility policy.
  9. In cases where the client consented to have his family informed of his care, the family should be notified of the use of restraints.

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