Physical restraints are specialized medical devices used in healthcare settings to temporarily limit a patient’s movement. Their application is considered a measure of last resort, implemented only when a patient’s behavior poses an immediate physical risk to themselves or others, or when necessary to facilitate life-sustaining medical treatment. Because restraints pose risks to a patient’s well-being, strict, time-sensitive protocols must be followed to ensure safety and dignity. These protocols are mandated by regulatory bodies and vary depending on the clinical situation, such as whether the use is for medical/surgical reasons or the management of violent behavior.
Required Observation and Continuous Monitoring
The most frequent requirement when a patient is physically restrained involves direct, visual observation of their status and behavior by trained staff. For patients restrained due to violent or self-destructive behavior, continuous, one-to-one observation is often mandated, meaning a staff member must maintain an unobstructed view of the patient at all times. This constant presence allows for immediate intervention if the patient attempts to escape or experiences distress.
In this high-risk scenario, a qualified staff member documents the patient’s behavior and physical status frequently, typically every 15 minutes. This detailed monitoring focuses on immediate safety concerns, including signs of physical injury, consciousness, and respiratory status. For patients in non-violent, medical restraints (e.g., to prevent the removal of a breathing tube), observation frequency may be less intense but is still highly regular, often involving checks at least every hour or two. The goal is to ensure immediate safety and determine the earliest moment the device can be safely removed.
Physical Release for Circulation and Skin Checks
Beyond continuous observation, regulatory standards mandate the physical removal of the restraint devices at set intervals to assess for physical complications. The standard minimum frequency for this hands-on intervention is generally every two hours, regardless of the reason for the restraint. The purpose of this scheduled release is to perform specific physical assessments that cannot be done effectively while the device is in place.
During the release, staff check the skin integrity underneath the restraint for signs of redness, abrasions, or pressure ulcers, which can develop quickly due to friction or impaired blood flow. They also assess the circulation distal to the restraint by checking pulses, skin color, and capillary refill. This window is also used to perform range of motion exercises on the restrained limbs to maintain muscle function and joint mobility. The physical release and subsequent assessment must be documented, noting the condition of the skin, circulation status, and the patient’s response.
Addressing Hygiene and Physiological Needs
Staff must frequently address the patient’s fundamental human needs, aligning with the minimum two-hour interval for physical release. The patient must be offered opportunities for toileting and elimination. This step is important for maintaining dignity and preventing complications like skin breakdown or urinary tract infections.
Staff are also responsible for offering hydration and nutrition at regular intervals. Comfort measures, such as repositioning the patient to alleviate pressure, are also provided at this time. Even if the patient refuses these offers, the act of assessing and offering basic needs must be completed and documented to demonstrate comprehensive care.
Mandatory Reassessment and Order Renewal
The continued use of a physical restraint is governed by strict time limits that require mandatory reassessment and order renewal by a healthcare provider. The maximum duration for a single order varies significantly based on the patient’s age and the clinical setting. For adults restrained for violent behavior, the initial order can typically last no longer than four hours before requiring renewal.
Time Limits Based on Age and Purpose
Children and adolescents have shorter order limits; those aged 9 to 17 may have an order valid for only two hours, and children under nine for just one hour. For restraints used for medical or surgical purposes, the order may be valid for up to 24 hours. A qualified provider must still conduct a face-to-face assessment of the patient within a specified timeframe, often within one hour of the initial application.
Renewal Process
After the initial order expires, a provider must re-evaluate the patient in person and write a new order with a clinical justification for the continued need. The primary goal is always to discontinue the restraint at the earliest possible time.