The use of physical restraints in healthcare balances patient safety with the right to freedom of movement. A physical restraint is any manual method or mechanical device that restricts a patient’s ability to move their body or limbs freely, used to manage behavior rather than for standard medical treatment. Because restraints limit personal liberty, their application is strictly regulated to ensure they are used safely and only for the shortest time necessary. Regulations focus heavily on mandatory timeframes for release, re-evaluation, and continuous monitoring.
Justification for Using Restraints
Physical restraints must never be used for staff convenience, punishment, or to manage staffing shortages. Their application is only permissible to ensure the immediate physical safety of the patient, other patients, or staff members. This includes preventing a patient from causing immediate harm to themselves (e.g., removing life-sustaining medical devices) or preventing harm to others. Restraints must be considered a last resort, implemented only after less restrictive interventions have failed, and must be authorized by a formal, time-limited order from a licensed independent practitioner.
Mandatory Timeframes for Release and Re-evaluation
The use of restraints requires time-limited orders and mandatory re-evaluation, which dictates how often a patient must be formally reassessed. Maximum durations for initial orders are strictly regulated based on the patient’s age and the reason for the restraint.
Behavioral Restraints
Restraints used to manage violent or self-destructive behavior have strict time limits. Orders are limited to four hours for adults aged 18 and older. Adolescents (ages nine to 17) have a maximum duration of two hours, and children under nine are capped at one hour. If the restraint is still necessary after the initial order expires, a new order must be obtained, requiring a face-to-face re-assessment by a licensed independent practitioner.
Medical-Surgical Restraints
For restraints used to protect a patient from non-behavioral risks (medical-surgical restraints), the initial order may be valid for up to 24 hours. Regardless of the order duration, a qualified professional must assess the patient in person within one hour of the restraint’s initiation. This mandatory assessment confirms the necessity of the restraint and ensures the least restrictive method is used.
Continuous Safety Checks and Patient Monitoring
Healthcare regulations mandate high-frequency, continuous monitoring of the patient while restraints are in use, typically performed by nursing staff. The most frequent requirement is continuous visual or audio monitoring, often specified as checks every 15 minutes for behavioral restraints. During these checks, staff must assess the patient’s physical well-being, including circulation, skin integrity, and range of motion at the restraint sites. Staff must also temporarily release the restraint for comfort and basic needs—such as hydration, toileting, and skin care—every one to two hours. Meticulous documentation of all checks and comfort interventions is required.
Criteria for Discontinuation
Restraints must be removed at the earliest possible moment, even if the time-limited order has not expired. The primary criterion for discontinuation is that the immediate safety risk that necessitated the restraint has passed. Staff must continuously assess if the patient has met the specific behavioral goals established upon application. For a patient restrained due to violent behavior, discontinuation is warranted when the patient is calmer and demonstrates control. For medical restraints, removal is appropriate when the patient’s condition has stabilized or the protected devices have been discontinued.