| Indications |
To prevent behavior that interferes with medical treatment or healing, often due to confusion, agitation, or disorientation related to a medical condition. |
To manage behavior that poses an immediate risk of physical harm to the patient, staff, or others. |
| Behavioral Examples |
Preventing a confused patient from pulling out IV lines, catheters, feeding tubes, or dressings; preventing injury in a disoriented patient trying to get out of bed unsafely after other measures failed. |
Physically aggressive acts (hitting, kicking), attempts to harm self (head banging), credible threats of imminent violence. |
| Types of Restraints |
Soft Limb Holders: Fabric or soft material cuffs for wrists or ankles, secured with Velcro or ties to the bed frame (not side rails). Used to limit movement and prevent pulling at IV lines, catheters, drains, or endotracheal tubes.
Secured Mitts: Mittens placed over the hands and secured (e.g., with ties to the bed frame or integrated straps) to prevent patients from using their fingers to grasp tubes or scratch skin. Note: Unsecured mitts are typically not considered restraints.
Roll Belt / Safety Belt: A belt placed around the patient's waist or hips, secured to a bed or chair, to prevent them from falling or climbing out when assessed to be unsafe to do so (e.g., due to confusion, impulsivity related to medical condition).
All 4 Side Rails Raised: Considered a restraint only when all four rails are used with the specific intention of preventing the patient from voluntarily getting out of bed. Requires careful assessment and justification, as it can increase fall risk if the patient attempts to climb over.
Enclosure Beds (e.g., Vail Bed, Posey Bed): Beds with soft mesh netting zipped around the patient. Depending on hospital policy, these may be considered restraints but are often viewed as less restrictive than limb restraints for certain patients (e.g., highly agitated, mobile, risk of falling).
Geri-Chair with Locked Tray Table: A chair where the tray table locks in place and prevents the patient from rising, if the patient cannot easily remove it themselves. |
Manual/Physical Hold: Staff physically holding a patient to restrict their movement during an acute behavioral crisis. This is considered a restraint and is subject to time limits, assessment, and documentation requirements. It's often temporary while other interventions (medication, mechanical restraints) are prepared.
Soft Limb Holders (often 4-point): Applying soft restraints to both wrists and both ankles, secured to the bed frame, to manage severe physical aggression or self-injury.
Hard/Locked Limb Restraints (Less Common): Leather or locking plastic restraints. Typically used only in specialized settings (e.g., psychiatric units, intensive care units, forensic units) for extreme aggression where soft restraints are ineffective or compromised.
Seclusion: Placing the patient involuntarily alone in a locked room specifically designed for safety (e.g., minimal furnishings, observation window). This is only used for managing violent/self-destructive behavior and requires intensive monitoring.
Chemical Restraint: Administering medication (e.g., sedatives, antipsychotics) primarily to control severe agitation or aggression and restrict movement, when the medication/dosage is not part of the patient's standard treatment plan for an underlying condition. This requires a specific order, clear indication, and careful monitoring. |