Patient restraints are highly regulated interventions used in healthcare settings to protect a patient or others from immediate physical harm. These measures involve devices or medications that intentionally restrict a patient’s freedom of movement. Restraints are only used after all less restrictive, de-escalation methods have been attempted and failed. The goal is always the patient’s immediate physical safety, and the intervention must be discontinued as soon as the dangerous situation is resolved.
The Difference Between Physical and Chemical Restraints
The rules governing restraint duration depend heavily on the type used. Physical restraints are mechanical devices that directly restrict a patient’s movement. Examples include wrist and ankle restraints, safety vests, or belts used to secure a patient to a bed or chair. These devices prevent the patient from pulling out medical lines, falling, or physically harming themselves or staff.
Chemical restraints involve using psychoactive medications to intentionally restrict a patient’s behavior or movement. This classification applies when the drug or dosage is not standard treatment for the patient’s underlying medical condition. For example, using a sedative during intubation is standard medical care, but administering an antipsychotic drug solely to manage aggressive behavior is a chemical restraint. The use of either type must be clinically justified, ordered by a licensed provider, and documented in the patient’s medical record.
Regulatory Time Limits for Restraint Orders
The maximum duration of a restraint order is strictly governed by federal standards, primarily set by the Centers for Medicare & Medicaid Services (CMS). These standards are often adopted by accrediting bodies like The Joint Commission (TJC). These time limits ensure the intervention is temporary and the patient’s condition is continuously re-evaluated. The regulations apply specifically to restraints used for managing violent or self-destructive behavior that poses an immediate danger.
The initial order for a restraint is time-limited, with maximum duration determined by the patient’s age. For adults (age 18 or older), the initial order cannot exceed four hours. For adolescents (ages 9 to 17), the time limit is two hours. For children under age 9, the maximum initial order is limited to one hour.
If the patient’s behavior continues to pose a risk past the initial time limit, a new order is required. Before the order can be renewed, a physician or licensed independent practitioner must conduct a face-to-face evaluation of the patient. This evaluation determines if the restraint is still clinically necessary and if the patient’s plan of care needs modification.
The total time a patient can remain continuously restrained under the same initial assessment is capped. After the initial period and subsequent renewals, a new, comprehensive assessment by a physician is mandatory after 24 hours. This 24-hour limit forces the care team to fully re-evaluate the patient’s condition and the continued necessity of the intervention. These time frames represent the legal maximum for the order’s duration, not a goal for how long the patient should remain restrained. The professional requirement is to discontinue the restraint at the earliest possible moment the patient is safe, even if the order has not yet expired.
Mandatory Monitoring and Reassessment Procedures
Regardless of the order’s time limit, the patient must be continually monitored and receive ongoing interventions while restrained. This mandatory monitoring ensures safety and prevents complications arising from restricted movement. For patients in physical restraints, a trained staff member must observe the patient continuously or at very frequent intervals, often specified as every 15 minutes.
Staff must perform regular checks to address the patient’s physical needs and prevent potential injuries. These checks include assessing circulation in the restrained limbs (skin color, temperature, and pulses). Mandatory checks also involve addressing the patient’s needs for:
- Hydration
- Nutrition
- Hygiene
- Elimination
Staff also perform scheduled range-of-motion exercises to prevent stiffness and muscle injury.
A continuous component of care is providing psychological and emotional support to the restrained patient. Staff must assess the patient’s physical and psychological comfort and communicate about the situation. The patient is informed about the specific behaviors that, if demonstrated, would lead to the immediate discontinuation of the restraint.
The fundamental requirement is constant reassessment to determine if the restraint can be safely removed. Staff must look for any change in the patient’s behavior or condition indicating the immediate danger has passed. If the patient’s behavior stabilizes, the restraint must be discontinued immediately, even if the written order allows for a longer duration. The physician’s order sets the legal maximum, but patient safety dictates the earliest possible release.