Patient restraint, whether physical or chemical, is an intervention used in healthcare settings to ensure the immediate safety of the patient, staff, or others. Because this measure restricts a patient’s autonomy, strict monitoring protocols are mandated to protect their rights and physical well-being. Regulatory bodies require continuous assessment and frequent checks to prevent complications such as injury, respiratory distress, or circulatory impairment. These mandates establish minimum standards that all facilities must meet.
Differentiating Types of Restraints
The frequency of monitoring is directly tied to the reason the restraint was applied, which falls into two main categories. Behavioral Health Restraints are used when a patient poses an immediate danger to themselves or others due to a psychiatric or behavioral health emergency, specifically to manage violent or self-destructive behavior. Medical/Surgical Restraints, in contrast, are used to support medical healing and are not related to managing aggressive behavior. An example includes securing a patient’s hands to prevent them from inadvertently removing an intravenous line, a feeding tube, or a life-sustaining ventilator tube.
Mandatory Time Intervals for Patient Checks
The maximum time intervals for checking a restrained patient are defined by federal regulations and accreditation standards. For patients in Behavioral Health Restraints, continuous observation is required, typically documented through a hands-on or face-to-face assessment by a trained staff member every 15 minutes. Within one hour of initiation, a licensed independent practitioner or a trained registered nurse must conduct a face-to-face evaluation to determine if the restraint remains necessary and to assess the patient’s reaction.
The initial order for behavioral restraints is strictly time-limited: a maximum of four hours for adults, two hours for children aged 9 to 17, and one hour for children under nine. If the restraint must be continued, a licensed independent practitioner must conduct a full reassessment and issue a new order.
For Medical/Surgical Restraints, the mandatory assessment frequency is less stringent. While federal regulations do not specify a precise time frame, hospital policies commonly require a visual check and documentation of the patient’s condition every two hours. Regardless of the type of restraint, a physician must re-evaluate the patient and renew the order at least every 24 hours.
Components of a Safety Check
Every required safety check involves both a physical assessment and a psychological evaluation to ensure the patient’s well-being. Physical monitoring focuses heavily on circulation and skin integrity, especially in the area distal to the restraint device. Staff check for changes in skin color, temperature, swelling, and the presence of a pulse or capillary refill in the restrained extremities. The assessment also includes checking for any signs of skin breakdown, bruising, or abrasions under the restraint device or over bony prominences.
Respiratory status is also a mandatory component, as restraints can sometimes compromise breathing. Staff must also address basic physical needs by offering fluids, nourishment, and assistance with toileting or elimination. The psychological component requires assessing the patient’s emotional state, level of distress, and agitation. Staff must also assess the patient’s mental status and cognitive functioning, looking for improvement or deterioration. During these checks, the patient must be offered opportunities for range of motion exercises or a brief release of the restraint, if clinically appropriate and safe.