Restraints, What's Unacceptable?

[Hooch]

Thought I'd start a general discussion on the use of restraints, giving us the opportunity to discuss how common it is, the ethics, professional and legal implications, and what you may have come across in the course of your professional practice.

As we all know there are three forms of restraints, those being chemical, physical and environmental. I always understood that the use of restraints should always be used as a last resort, and only when there's an imminent risk of harm, and it should always be the least restrictive. Here where I come from the national policy is to eliminate the use of all restraints, or if it's not possible after weighing up the risk versus harm, to use the least restrictive means of restraint. While we're told that we need to perform a full assessment on the patient before prior to any episode of restraint, do we do this? While it goes without saying that restraints should never be used to make our work easier, how often do we really question what we're doing?

What kind of restraints have you come across and have you ever questioned whether the restraint that was being used was a bit OTT or necessary? While some of us have come across and accept the need for locked psychiatric units, how many of us have come across other environments where the entranceways to wards are locked? Again, where I come the entrances to the floor in ED's are generally locked to control access to the floor, with the added benefit of an electronic release button if staff, patients or relatives want to leave. So in that context, that's not really a form of restraint. However, I've also come across other environments where doors to wards are electronically locked and can only be released by members of staff. Curiously, they are not psychiatric or care of the elderly dementia units, they are wards where post-op surgical patients are getting rehab.

So tell us your experience, what have you come across that led you to question, is this legal, and why are we doing it? How did management or colleagues react, if you questioned if the use of restraints was entirely appropriate?

[jadelpn, LPN, EMT-B]

There are a number of threads on AN regarding questionable use of restraints. Some with a general theme of if the patient is annoying, just restrain them. This is poor practice at the highest level, in my opinion. Patient safety is one thing, but putting someone in restraints for convenience sake is another.

Per TOS, and not giving legal advice, there are laws and legal guidelines regarding the use of restraints. They can vary by type of facility. It is imperative that you know your facility policy on restraint use, and that you follow those policies to a "T". That you document accordingly.

Locked units can be for security reasons. You should always be able to get out of them, but it controls who can get into them.

Most facilities use the least restrictive means. You DO need to assess a patient before, during, and after restraint use. Per your facility policy.

[kbrn2002, ADN, RN]

"Here where I come from the national policy is to eliminate the use of all restraints, or if it's not possible after weighing up the risk versus harm, to use the least restrictive means of restraint."

Does this mean you are not USA?

I don't want to get into legalities [ it is against AN TOS anyway as jadelpn indicated above], besides the laws and facility policies vary greatly.

Personal experience only:

Years ago we used vest restraints, chair restraints, bed restraints, just about everything but 4 point restraints. It is pretty comical looking at the expression on a newer nurses face when I explain these contraptions to them. We never did use chemical or environmental restraints. We have been restraint free for several years now and I don't miss it at all. Not only do the risks usually far outweigh the benefits, the documentation required was massive.

[Altra, BSN, RN]

OP, please consider the security function of locked/limited access units, and consider the regulatory environment in which we practice. Across long term care, subacute, and acute care ... if Patient X cannot be physically located or accounted for by staff, for even 2 minutes, that is a regulatory offense reportable to various regulatory agencies.

[JustBeachyNurse, LPN]

"Here where I come from the national policy is to eliminate the use of all restraints, or if it's not possible after weighing up the risk versus harm, to use the least restrictive means of restraint."

Does this mean you are not USA?

I don't want to get into legalities [ it is against AN TOS anyway as jadelpn indicated above], besides the laws and facility policies vary greatly.

Personal experience only:

Years ago we used vest restraints, chair restraints, bed restraints, just about everything but 4 point restraints. It is pretty comical looking at the expression on a newer nurses face when I explain these contraptions to them. We never did use chemical or environmental restraints. We have been restraint free for several years now and I don't miss it at all. Not only do the risks usually far outweigh the benefits, the documentation required was massive.

It appears OP is from Ireland.

[~PedsRN~, BSN, RN]

We lock down our unit - we are a children's hospital, and it's imperative no one gain access to these kids that shouldn't have access to these kids. I don't think having a secretary ID you and buzz you in and out of a unit is comparable to being restrained.