The use of medical restraints in professional healthcare settings is sometimes necessary to help ensure patient safety. Medical restraints can also be used to protect the safety of caregivers and other staff members, as well as other patients and visitors.
Medical restraints, regardless of type, are intended for use only as a last resort to prevent patients from harming themselves and/or to prevent them from harming others. It should be noted, of course, that using any type of restraint for punishment or for caregiver convenience is never permissible. Medical restraints are intended solely to help safeguard patients and/or those around them. Restraint use should be discontinued immediately once it is safe to do so.
Nurses should receive comprehensive, up-to-date training on the appropriate use of patient restraints. It is imperative that these frontline medical professionals possess a full understanding of both how and when to use restraints, so they are capable of doing so in an effective, ethical, and lawful manner.
The patient’s present behavior determines if the use of a restraint is warranted. The U.S. Centers for Medicare and Medicaid Services (CMS) defines two different types of behavior that could warrant the use of restraint or seclusion: non-violent, non-self-destructive (NVNSD) behavior and violent, self-destructive (VSD) behavior.1
Restraints should never cause harm. If the use of a restraint is deemed necessary, the least restrictive effective measure should be applied. The patient’s condition must always be taken into consideration when making restraint-related decisions.
Hospitals and other healthcare facilities are expected to adhere to applicable guidelines and standards published by federal and state governing agencies (e.g., CMS1) and accrediting organizations (e.g., The Joint Commission, TJC2).
Now, let’s look at the categories into which medical restraints are commonly grouped.
The remainder of this article will focus on several different types of physical restraint devices available for use in hospitals and other healthcare facilities.
It is important for healthcare professionals to have a solid working knowledge of their own facility’s “least restrictive to most restrictive” spectrum of available physical restraints and restraint alternatives (see the example provided). When restraint use is warranted, the least restrictive potentially effective measure should be considered first. Only if this option proves insufficient should more restrictive options be considered incrementally.
The following sections briefly describe several different types of patient restraint devices and restraint alternatives.
Vest restraints are designed to help prevent unassisted wheelchair, bed, and stretcher exits. Considered one of the more physically restrictive types of patient restraints available for professional use, these sleeveless garment-style devices can be secured to a wheelchair, bed, or stretcher as indicated.
Limb restraints (limb holders) are also considered to be among the more physically restrictive devices available to healthcare professionals. They are designed to limit the movement of wrists and/or ankles in patients assessed to be at risk of disrupting life-saving treatment, pulling lines/tubes, exacerbating skin conditions, compromising wound site integrity, or self-injury.
Sometimes these devices are referred to as being either soft restraints or hard restraints, depending on specific features such as cuff and strap materials and whether or not they can be locked. Limb holders are designed for attachment to a bed or stretcher as indicated.
Enclosure beds are designed to provide a safe, controlled environment for patients at risk of injury from an unassisted bed exit. Use of enclosure beds can help eliminate the need for more restrictive devices like limb holders or vest restraints.
Belts are designed for use with patients who need a reminder to call for assistance before exiting a hospital bed or wheelchair, for limiting unassisted exit and unwanted movement, or for patients who require a positioning device for added safety or to assist medical treatment.
Belts can be made from a variety of materials, can offer locking capabilities, and can be designed specifically to allow patients to self-release. Related medical devices include straps, wraps, torso supports, and pelvic holders. Belts and similar medical devices can be attached to a hospital bed, wheelchair, stretcher, chair, OR table, exam table, or treatment table as indicated.
A belt’s specific features help determine if it is considered a less restrictive or more restrictive device. In some states and facilities, belts are not considered restraints.
Mitts are designed to help protect patients who are prone to disrupting medical treatment or to self-harm. Mitts hinder picking and tube pulling. Their construction and padding varies, as does the level of hand visibility afforded and the degree of finger movement permitted. Mitts that include an inspection flap allow caregivers quick access to the patient’s hand.
Mitts are generally considered to be less physically restrictive devices, and in some states and facilities they are not considered restraints.
Multipurpose sleeves are designed to limit or minimize patient arm movements without the use of rigid splints. Multipurpose sleeves are in the least restrictive device category, and in some states and facilities they are not considered restraints.
Healthcare professionals should remember that whenever possible, de-escalation techniques and diversionary devices should be tried before the decision is made to use any type of restraint.
Diversionary devices such as activity aprons and fidget sensory aids, for example, are designed to provide stimulating activities and textures for patients with decreased cognitive function and/or requiring tactile stimulation. Additionally, some mitts are designed with bead fillings for use as diversionary devices.
Contact us today to learn more about medical restraints and restraint alternatives.