restraint question?

[sassyann8585]

Hi everyone!

Quick question... I know we are always supposed to use the least restrictive measure first...for a patient who is very combative, would you need to document that you TRIED soft restraints before applying leather or vinyl restraints? I am confused-if a patient is acutely violent and having an outburst and throwing furniture, if you restrain them and try to use soft restraints, how do you decide which type of restraint to use? Also, how do you decide between using restraint as opposed to seclusion and vice versa? Thanks!

[Whispera, MSN, RN]

Where I've worked, we didn't even have soft (the light blue Posey) restraints. We went right to the Velcro restraints if restraints were needed. A strong person can get out of those light blue restraints and can even pull them apart. Restraints are last choice and only if the person is a danger to self or others. You wouldn't seclude someone who is a danger to self, because teeth and fingernails can do lots of damage in seclusion. Also, sometimes you have to restrain in order to medicate.

[MrChicagoRN, RN]

A limb restraint is a limb restraint.

if you've been unsuccessful with verbal deescalation, quiet environment, etc that leaves seclusion (requires continuous observation) and then after that wrist and ankle restraints. If a person is weak and frail you could use the soft restraints but on an inpatient unit you'll probably just have the locking type. These are safer as escape is unlikely, reducing the chance of detaching the restraints and asphyxiating oneself.

[Meriwhen, ASN, BSN, MSN, RN]

I agree: a restraint is a restraint is a restraint. It doesn't matter if it's made of canvas, leather or Pixie-sticks--if you're resorting to any restraint, it's because it's a last resort to be used when all other less intensive interventions were tried and have failed.

However, the degree you restrain a person can vary considerably. Four point/all limbs is more restrictive than two point/arms only. Pinning someone's arms is a lot more restrictive than applying mittens. But it's all still restraint.

As for seclusion versus restraint...I'd say that could also involve whether the patient's unsafe behavior is aimed towards themselves or towards others. If a patient really wants to hurt themselves, they can easily do it while in seclusion--they have four walls, a floor and possibly a bed corner against which they can bang themselves against.