Physical restraints are mechanical devices or materials attached to a patient’s body that restrict movement and cannot be easily removed. These measures are only used as a last resort to ensure the immediate physical safety of the patient or others, such as preventing self-harm or the dislodging of life-sustaining equipment. Restraints must never be used for staff convenience or punishment. The necessity of the restraint must be regularly assessed and discontinued at the earliest possible time.
Rationale for Time-Limited Use
Prolonged physical restraint is associated with serious adverse physical and psychological consequences. Extended immobility can lead to circulation impairment, increasing the risk of deep vein thrombosis (DVT). Pressure from the restraints and restricted movement can rapidly cause skin breakdown, leading to pressure injuries or ulcers.
Restricting movement contributes to muscle atrophy and physical deconditioning, resulting in a decline in a patient’s mobility and functional status. The psychological impact includes increased agitation, anger, and fear, often leading to a loss of dignity and an increased risk of post-traumatic stress disorder (PTSD). These harms establish the imperative for routinely removing restraints to provide necessary care.
Standard Removal Frequency Protocols
The standard protocol mandates that physical restraints must be removed at least every two hours to prevent harms associated with prolonged restriction. This two-hour interval is a regulatory benchmark for medical or surgical restraints used to protect tubes, lines, or wounds in non-violent patients. Failure to adhere to this frequency constitutes a serious lapse in patient care and regulatory non-compliance.
Patients in behavioral health restraints, used to manage violent or self-destructive behavior, require stricter monitoring. These patients must be continuously monitored, typically with one-to-one observation, and assessed by a qualified nurse at least every two hours for interventions. The requirement for a physical release of the restraint for care activities is consistent regardless of the reason for application.
Essential Care Activities During Removal
The mandatory removal period is dedicated to providing specific interventions that address the physical and psychological toll of restriction. During this time, staff must perform several essential care activities:
- Reposition the patient to shift weight-bearing areas and prevent pressure ulcers.
- Perform range of motion (ROM) exercises on the restrained limbs to prevent joint stiffness and contractures.
- Offer essential hygiene and elimination care, such as offering a bedpan or assistance with toileting, which maintains skin integrity and patient dignity.
- Provide nutrition and hydration, ensuring basic physiological needs are met.
- Address the patient’s comfort and psychological needs through conversation and reassurance.
Assessment and Documentation Requirements
Before the restraints are reapplied, an assessment must be performed and documented to ensure patient safety and compliance. A detailed check of skin integrity is required, focusing on the areas where the restraint devices were placed, looking for signs of redness or skin breakdown. Circulation checks must also be performed on the restrained extremities by assessing peripheral pulses, capillary refill time, and limb temperature to confirm adequate blood flow.
A reassessment of the patient’s condition is necessary to determine if the underlying reason for the restraint still exists. The restraint must be discontinued immediately if the patient’s behavior or medical condition no longer warrants the restriction, emphasizing that it is not a fixed duration intervention. Documentation must precisely log the time the restraints were removed, the specific care provided during the release, the results of the skin and circulation assessment, and the time and rationale for reapplication.