Restraints

________________________________________________________________________

KEY POINTS

• A restraint is something that limits a person’s movement to help keep them safe in a healthcare setting. Restraints can be medicine, side rails on beds, soft ties, or other physical devices.
• Restraints are used as a last resort because they can cause several kinds of problems. If you have concerns about the use of restraints, contact the person’s healthcare provider or nursing facility ombudsman. The phone number is posted in every nursing facility.

________________________________________________________________________

What are restraints?

A restraint is something that limits a person’s movement in a healthcare setting. Restraints can be physical devices or medicine.

• Physical restraints include soft ties for arms, legs, or hands; vests tied to a bed or chair; hand mitts; lap boards attached to chairs; and side rails on beds.
• Medicines can also be used to slow or limit movement.

Why might restraints be used?

Restraints are used to try to help keep people safe. They may be used to:

• Keep people with severe mental illness from hurting themselves or others.
• Keep someone from pulling at or damaging a breathing tube, IV line, catheter, or other needed medical equipment.
• Help protect someone from injury—for example, to stop them from falling out of bed or from a wheelchair.
• Keep someone still during surgery or treatment.

When restraints are used, they should:

• Limit only the movements that may cause harm to the person or to caregivers.
• Be removed as soon as the person and caregivers are safe.

Are there problems with restraints?

Restraints are used as a last resort because they can cause several kinds of problems.

• A person who is restrained may feel like they are being punished. They may feel like a prisoner. They may be afraid, angry, or depressed.
• Being restrained can cause stress and make blood pressure higher. If the person does not understand what is happening, they may struggle against the restraints and get injured.
• If someone is restrained for a long time, their muscles and bones get weaker.
• The restraint may bruise or tear the skin, or cause pressure ulcers if left in place too long.
• People who are restrained may not eat well and may drink less than they need to stay healthy. They may get constipated from not being able to move around. They may also have problems controlling their bladder.
• If not used properly, restraints can cut off blood flow or cause breathing problems or choking.

Are there other ways to keep a person safe?

There are other options, depending on why the person is being restrained.

• An alarm can be used that sounds when a person starts to get up from a chair or bed.
• If a person is upset, it may help to speak calmly, play soothing music, and have someone stay with the person.
• If falling out of bed is the main concern, a mattress can be put on the floor.
• If the problem is wandering, it may help to put alarms on doors.
• To help a person stay in position, padded furniture or special cushions may help.
• To keep someone from pulling out tubes, the tubes can be hidden or the treatment may be given in a different way.

What are the laws about using restraints?

How a person can legally be restrained is based on laws and regulations that affect healthcare facilities. When a person is restrained, the staff must constantly watch to make sure the person is safe.

If you have concerns about the use of restraints, contact the person’s healthcare provider or nursing facility ombudsman. The phone number is posted in every nursing facility.