what are chemical restraints?

MrChicagoRN, RN · Feb 12, 2014

No, it's not a chemical restraint because you are giving it to induce a therapeutic effect, and to do what Ativan is intended to do.

A chemical restraint is given for a purpose other than it's intended use, and given for punishment, coercion, or convenience

Heres a recent link that should help. It also contains CMS & TJC definitions of chemical restraints:

https://allnurses.com/nursing-issues-patient/restraints-903896.html

Feel free to ask more questions if you need to.

beckyboo1, BSN, RN · Feb 12, 2014

Our policy states any med that may sedate or otherwise change the pt's sensorium and is not a part of his regular med regimen is technically a chemical restraint. Personally, if I am out of control and in danger of hurting myself, I'd rather be sedated than to be tied down. I do, however, agree that there are times when those meds can be used inappropriately. It doesn't mean all chemical restraint situations are inappropriate. Also, we document to high heaven that we have tried everything imaginable first. Most times, we end up trying a 1:1 sitter before chemical restraint

beckyboo1, BSN, RN · Feb 13, 2014

No, it's not a chemical restraint because you are giving it to induce a therapeutic effect, and to do what Ativan is intended to do.

From the Joint Commission site Standards FAQ Details | Joint Commission

The Joint Commission follows the CMS definition of restraint, which is as follows:"The 42 CFR (Code of Federal Regulations)482.13(e)(1) Definitions (i) A restraint is— (A) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely; or 42 CFR 482.13(e)(1)(i)(B) (A restraint is— ) A drug or medication when it is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition.

As I read this, your Ativan is for managing behavior and is not part of their standard medication regimen, therefore, it is still a chemical restraint. Not ALL chemical restraints are inappropriate. And if it's me who is out of control and in danger of hurting myself or others, I'd rather you try chemical restraint before strapping me to a bed.

sassyann8585 · Feb 13, 2014

From the Joint Commission site Standards FAQ Details | Joint Commission
The Joint Commission follows the CMS definition of restraint, which is as follows:"The 42 CFR (Code of Federal Regulations)482.13(e)(1) Definitions (i) A restraint is— (A) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely; or 42 CFR 482.13(e)(1)(i)(B) (A restraint is— ) A drug or medication when it is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition.
As I read this, your Ativan is for managing behavior and is not part of their standard medication regimen, therefore, it is still a chemical restraint. Not ALL chemical restraints are inappropriate. And if it's me who is out of control and in danger of hurting myself or others, I'd rather you try chemical restraint before strapping me to a bed.

Beckyboo-

you are referring the Ativan in the second example being a chemical restraint, right? (the medical scenario d/t "is not a standard treatment or dosage for the patient's condition." But with a psych patient, Ativan IS a standard tx for condition (say pt has depression and anxiety) so it's NOT a chemical restraint in this case, am I correct?

thanks!

beckyboo1, BSN, RN · Feb 13, 2014

do you mean in a psychiatric unit or just a pt on a med surg unit with a psych diagnosis? On our unit (med/surg/tele) if the Ativan was a brand new order just to calm a pt who is a danger to himself or others, it's a chemical restraint, doesn't matter if he is a "psych pt" or not. I really didn't care for the reference from MrChicago that chemical restraints are ONLY used for coercion or nurse convenience.

BlueLightRN · Feb 13, 2014

A chemical restraint is something that is used to sedate or otherwise incapacitate a person, not a medication that is used to help the patient. If the patient is hyperventilating and freaking out harming themselves or others, making themself sick,etc., some ativan will help them. If a patient is just being loud and disruptive, but isn't in distress themselves or harming anyone else doping them up with ativan to keep them quiet is chemically restraining them.

MrChicagoRN, RN · Feb 13, 2014

do you mean in a psychiatric unit or just a pt on a med surg unit with a psych diagnosis? On our unit (med/surg/tele) if the Ativan was a brand new order just to calm a pt who is a danger to himself or others, it's a chemical restraint, doesn't matter if he is a "psych pt" or not. I really didn't care for the reference from MrChicago that chemical restraints are ONLY used for coercion or nurse convenience.

It's not my definition:

CMS DEFINITIONS: Physical restraints are any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident?s body that the individual cannot remove easily which restricts freedom of movement or normal access to ones body. Chemical restraints are any drug used for discipline or convenience and not required to treat medical symptoms.

also:

"The JCAHO defines chemical restraint as the inappropriate use of a sedating psychotropic drug to manage or control behavior." See more at: http://www.psychiatrictimes.com/

http://www.cdph.ca.gov/programs/LnC/Documents/CAHPS-HSAG-White-Paper-Chemical-Restraint-Use-Final.pdf

Page 3 describes the expert consensus of describing the use of medications to control psychiatric symptoms should be described as therapeutic treatment not restraints.

To sassyann, you are correct that giving Ativan to any anxious patient to alleviate symptoms is not chemical restraints because you are giving it for it's intended purpose.

beckyboo1, BSN, RN · Feb 13, 2014

I took my quote directly from the JCAHO site thank you. And the 2nd link you posted says bad link, but also looks as if it's from Canada?

MrChicagoRN, RN · Feb 13, 2014

I took my quote directly from the JCAHO site thank you. And the 2nd link you posted says bad link, but also looks as if it's from Canada?

then you'll note that your quote states they follow CMS definition of chemical restraints.

Read your quote again. Your definition also refers to "standard treatment and dosage for the patient's condition." It doesn't say patient's usual condition, or usual medication, but refers to the current condition at the time it is given. Thus, not a restraint.

http://www.cdph.ca.gov/programs/LnC/Documents/CAHPS-HSAG-White-Paper-Chemical-Restraint-Use-Final.pdf

The link is a California Dept of Public Health White Paper on Chemical Restraints, not Canadian

Umberlee · Feb 13, 2014

I know we steer waaaaay away from the term "chemical restraint" here and always use the phrase "emergency medication" instead--however, as part of our admission process we are supposed to ask the patient if they prefer to be manually or chemically restrained in the event that they go into crisis *shrug*

MrChicagoRN, RN · Feb 13, 2014

I know we steer waaaaay away from the term "chemical restraint" here and always use the phrase "emergency medication" instead--however, as part of our admission process we are supposed to ask the patient if they prefer to be manually or chemically restrained in the event that they go into crisis *shrug*

I think it's great that you are asking the question of the patient, but it's the term that concerns me. To be in alignment with CMS & TJC definitions, they might want to come up with other verbage.

What do you think of asking, "if you find yourself in crisis and out of control while here, what helps you to regain that control?". Maybe add some more choices, like time out, seclusion, etc.