Patient restraints, including physical devices and certain chemical agents, are interventions used in healthcare settings to temporarily limit a patient’s movement or control their behavior. These measures are only employed as a last resort when a patient’s actions pose an immediate physical danger to themselves, staff members, or others. Restraints are never used for convenience, punishment, or as a substitute for adequate staffing or treatment. The application of any restraint initiates a strict protocol of frequent monitoring to protect the patient’s physical well-being and dignity. Due to the inherent risks, healthcare regulations mandate specific, time-sensitive checks to ensure patient safety and facilitate removal at the earliest opportunity.
Required Monitoring Frequency
The frequency of monitoring depends entirely on the reason for the restraint, a distinction driven by regulatory bodies. Restraints used to manage violent or self-destructive behavior, often termed behavioral restraints, require the most intense observation schedule. For these patients, a nurse or trained staff member must conduct face-to-face checks at least every 15 minutes to assess the patient’s immediate physical safety and psychological status. This frequent visual monitoring is mandated because patients restrained for behavioral reasons are at a higher risk for sudden physical distress, injury, or positional asphyxia.
The time limit for a single order of behavioral restraint is tightly controlled. It typically does not exceed four hours for adults. For children and adolescents aged nine to seventeen, the limit is generally two hours, and for children under nine, it is only one hour. If the restraint must continue beyond these limits, a physician or licensed independent practitioner must re-evaluate the patient and issue a new order. An in-person assessment by a healthcare provider is also required within one hour of application to confirm necessity.
In contrast, restraints used for medical or surgical purposes have a different monitoring standard. These non-violent physical restraints prevent patients from interfering with essential medical devices, such as endotracheal tubes or IV lines. They typically require a comprehensive assessment of physical needs and circulation at least every two hours. This check includes temporarily releasing the restraint for range of motion and repositioning, provided it is safe. Medical restraints often require continuous visual monitoring to ensure the restraint is not causing harm. The physician order for medical restraints can be renewed periodically, often every 24 hours, based on the patient’s ongoing clinical need.
Essential Assessments During Restraint
The monitoring check is a detailed evaluation of the patient’s well-being, far surpassing a simple visual confirmation.
Neurovascular and Skin Integrity Checks
A primary focus is a neurovascular assessment of any restrained extremity to check for signs of compromised circulation. Staff must confirm adequate blood flow by checking the color, temperature, and capillary refill of the limb distal to the restraint. They also assess sensation and motor function, ensuring the patient can still feel and move their fingers or toes, which confirms the restraint is not compressing nerves.
Staff must also assess the integrity of the patient’s skin beneath and around the restraint device. They check for signs of friction, redness, or pressure injury that could lead to skin breakdown. If the restraint is temporarily removed for a medical check, staff perform range of motion exercises to prevent stiffness and muscle injury.
Basic Needs and Psychological Status
The assessment addresses the patient’s basic human needs, including comfort, hygiene, and elimination. Staff must offer opportunities for toileting, hydration, and nutrition at regular intervals, even if the patient is agitated. The patient’s psychological status is monitored by assessing their level of agitation, orientation, and mental state. Vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation, are also routinely measured to detect physiological distress.
The Goal of De-escalation and Removal
Every monitoring check is a structured opportunity for staff to attempt de-escalation and assess the patient’s readiness for restraint removal. The goal is always to discontinue the temporary and restrictive intervention at the earliest possible time. Staff engage with the patient to determine if the behavior that initially necessitated the restraint has subsided.
The criteria for removal are based on the patient demonstrating they are no longer an immediate danger to themselves or others. This involves:
- The patient agreeing to follow instructions.
- A decrease in their agitation level.
- A resolution of the underlying medical condition causing the disruptive behavior.
Staff are trained to use nonphysical intervention skills and communication techniques during monitoring to help the patient regain self-control.
If a restraint is removed and the patient’s dangerous behavior immediately recurs, a new physician’s order is required to reapply it. Restraints can never be ordered on an “as needed” or “PRN” basis. The entire episode is continuously reviewed by the nursing staff and the physician to ensure the least restrictive environment is maintained for the shortest duration necessary.