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Restraints a tool of last resort for emergency intervention
When patients are a harm to themselves or others, here are the right ways to use these devices.
Assaultive or dangerous self-harming behaviors that cannot be redirected require fast action for everyone involved. When all efforts at therapeutic interventions do not contain dangerous behaviors, using locking restraints may be a tool of last resort.
Asante is committed to creating a safe care environment using preventive interventions and the least restrictive methods to manage behaviors.
The use of restraint and seclusion poses an inherent risk to the physical safety and psychological wellbeing of the patient and staff. For these reasons, use of restraints is highly regulated and guided by Asante policy Restraint and Seclusion, 400-PCS-NURS-0863.
The restraint policy was recently reviewed and updated to address fallouts and risk events. This information was also included in 2023 Clinical Elements modules and skill-based checklists.
| Opportunities to improve safe use of restraints | Policy and procedure updates |
| Using the wrong type of restraint.
Behavioral harm by patients can be a symptom of some medical and psychiatric illnesses. However, the type of restraint used is not distinguished by what the origins of their symptoms are. Patients on medical floors may require locking mechanical restraints for dangerous and violent behaviors. |
All medical floors now have access to a set of mechanical restraints to promote safety and use during emergencies. Skills training is required for all staff annually and as needed to support competency. |
| Prolonged use of restraints.
Every effort must be made to remove any type of restraint as soon as possible. Orders must be renewed before expiration to continue use.
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Nurses must initiate a care planning consult with the provider after four days of consecutive use of soft limb restraints.
Doctors must consult with a second physician to update the treatment plan after 24 hours of consecutive use of mechanical restraints. Epic now provides decision support through best-practice advisories, worklist tasks and required documentation to notify care team to address prolonged use of restraints and order renewals. |
| Patients have the right to be free of restraint. | Nursing must discontinue the order for restraints when they are removed. If they are needed again, a new order is required.
Notify the provider when behaviors change or when new symptoms occur. Use the chain of command if you are concerned that patient’s rights are being violated or if the staff are not safe with the current care plan. |
| Restraint orders and devices for violence are not the same as restraint orders for devices intended to stop interference with medical interventions.
Locking mechanical restraints are used for violence and are also called “leathers” or “4-points.” |
Federal and state guidelines direct all Asante policy and procedures for providers and nurses.
Time limits and rationale for use must be documented in orders and progress notes. Nursing documentation requirements are now part of the Epic worklist tasks for improved documentation compliance. |
| Restraints are never to be used PRN.
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Nursing must discontinue the order for restraints as soon as restraints are removed.
Currently there is no way for Epic to provide decision support for this. |
If you have questions, email [email protected]
If you need answers for a personal work matter, please contact the author or department directly instead of leaving a comment.
