Medical restraints
Encyclopedia
Medical restraints are physical restraint
s used during certain medical procedures. Medical restraints are designed to restrain patients with the minimum of discomfort and pain and to prevent patients injuring themselves or others.
There are many kinds of mild, safety-oriented medical restraints which are widely used. For example, the use of bed rails is routine in many hospitals and other care facilities, as the restraint prevents patients from rolling out of bed accidentally. Newborns frequently wear mittens to prevent accidental scratching. Some wheelchair users use a belt or a tray to keep them from falling out of their wheelchairs. In fact, not using these kinds of restraints when needed can lead to legal liability for preventable injuries.
Medical restraints are generally used to prevent people with severe physical or mental disorders from harming themselves or others. A major goal of most medical restraints is to prevent injuries due to falls. Other medical restraints are intended to prevent a harmful behavior, such as hitting people.
Ethically and legally, once a person is restrained, the safety and well being of the restrained person falls upon the restrainer, appropriate to the type and severity of the restraining method. For example, a person who is placed in a secured room should be checked at regular intervals for indications of distress. At the other extreme, a person who is rendered semi-conscious by pharmacological (or chemical) sedation should be constantly monitored by a well-trained individual who is dedicated to protecting the restrained person's physical and medical safety. Failure to properly monitor a restrained individual may result in criminal and civil prosecution, depending on jurisdiction.
Although medical restraints, used properly, can help prevent injury, they can also be dangerous. The United States Food and Drug Administration
(FDA) estimated in 1992 that at least 100 deaths occur annually in the U.S. from their improper use in nursing homes, hospitals and private homes. Most of the deaths are due to strangulation. The agency has also received reports of broken bones, burns and other injuries related to improper use of restraints.
Because of the potential for abuse, the use of medical restraints is regulated in many jurisdictions. At one time in California, psychiatric restraint was viewed as a treatment. However, with the passing of SB-130, which became law in 2004, the use of psychiatric restraint(s) is no longer viewed as a treatment, but can be used as a behavioral intervention when an individual is in imminent danger of serious harm to self or others.
Physical restraint
Physical restraint refers to the practice of rendering people harmless, helpless or keeping them in captivity by means such as handcuffs, fetters, straitjackets, ropes, straps, or other forms of physical restraint...
s used during certain medical procedures. Medical restraints are designed to restrain patients with the minimum of discomfort and pain and to prevent patients injuring themselves or others.
There are many kinds of mild, safety-oriented medical restraints which are widely used. For example, the use of bed rails is routine in many hospitals and other care facilities, as the restraint prevents patients from rolling out of bed accidentally. Newborns frequently wear mittens to prevent accidental scratching. Some wheelchair users use a belt or a tray to keep them from falling out of their wheelchairs. In fact, not using these kinds of restraints when needed can lead to legal liability for preventable injuries.
Medical restraints are generally used to prevent people with severe physical or mental disorders from harming themselves or others. A major goal of most medical restraints is to prevent injuries due to falls. Other medical restraints are intended to prevent a harmful behavior, such as hitting people.
Ethically and legally, once a person is restrained, the safety and well being of the restrained person falls upon the restrainer, appropriate to the type and severity of the restraining method. For example, a person who is placed in a secured room should be checked at regular intervals for indications of distress. At the other extreme, a person who is rendered semi-conscious by pharmacological (or chemical) sedation should be constantly monitored by a well-trained individual who is dedicated to protecting the restrained person's physical and medical safety. Failure to properly monitor a restrained individual may result in criminal and civil prosecution, depending on jurisdiction.
Although medical restraints, used properly, can help prevent injury, they can also be dangerous. The United States Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
(FDA) estimated in 1992 that at least 100 deaths occur annually in the U.S. from their improper use in nursing homes, hospitals and private homes. Most of the deaths are due to strangulation. The agency has also received reports of broken bones, burns and other injuries related to improper use of restraints.
Because of the potential for abuse, the use of medical restraints is regulated in many jurisdictions. At one time in California, psychiatric restraint was viewed as a treatment. However, with the passing of SB-130, which became law in 2004, the use of psychiatric restraint(s) is no longer viewed as a treatment, but can be used as a behavioral intervention when an individual is in imminent danger of serious harm to self or others.
Types of medical restraints
There are many types of medical restraint:- Four-point restraints, fabric body holders, straitjacketStraitjacketA straitjacket is a garment shaped like a jacket with overlong sleeves and is typically used to restrain a person who may otherwise cause harm to themselves or others. Once the arms are inserted into the straitjacket's sleeves, they are then crossed across the chest...
s are typically only used temporarily during psychiatric emergencies. - Lap and wheelchair belts, or trays that clip across the front of a wheelchair so that the user can't fall out easily, may be used regularly by patients with neurological disorders which affect balance and movement.
- Safety vests and jackets can be placed on a patient like any other vest garment. They typically have a long strap at each end that can be tied behind a chair in order to prevent the patient from getting out of the chair, or to the sides of a bed to keep the patient in bed. Posey vestPosey vestA Posey vest is a type of medical restraint used to restrain a patient to a bed or chair. Its name comes from the J.T. Posey Company, its inventor, though the term "Posey" is used generically to describe all such devices. The vest is placed on the patient, and meshy straps extending from each...
s are commonly used with elderly patients who are at risk of serious injury from falling. - Limb restraintLimb restraintLimb restraints are physical restraints that are applied to a person's arms or legs. The application of limb restraints on both arms and legs at once is sometimes known as a four-point restraint....
s are used to prevent activity in various limbs. They are wrapped around the wrists or ankles, and tied to the side of a bed, to prevent patients from harming themselves or others by preventing the patients from using their arms or legs. - Mittens to prevent scratching are common for newborns, but may also be used on psychiatric patients or patients who manage to use their hands to undo limb restraints.
- A Papoose boardPapoose boardIn the medical field a Papoose Board is a device used to keep a person, usually a child, immobilized during dental work, venipuncture, and other medical procedures. It is also sometimes used during medical emergencies to keep an individual from moving when total sedation is not possible...
can be used for babies and young children. - Chemical restraintChemical restraintA chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate a patient...
s are drugsMedicationA pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
that are administered to restrict the freedom of movement or to sedate a patient. Their use is heavily restricted. - A number of private national and regional companies teach physical (non-mechanical) restraint techniques for companies and agencies that care for or have custody of people who might become aggressive. The strategies vary widely, with many based on police or martial art pain-compliance techniques, with others using only pain-free techniques. Most also emphasize verbal de-escalation and defusing skills before using any physical skills. A non-inclusive list:
- The Mandt System.
- NAPPI (Non Abusive Psychological and Physical Intervention).
- NVCI (Non-Violent Crisis Intervention) techniques from CPI (Crisis Prevention Institute).
- ProACT (Professional Assault Crisis Training).
- TCI (Therapeutic Crisis Intervention).
Laws pertaining to medical restraints
Current United States law requires that most involuntary medical restraints may only be used when ordered by a physician. Such a physician's order, which is subject to renewal upon expiration if necessary, is valid only for a maximum of 24 hours.http://www.emedicine.com/emerg/topic776.htmExternal links
- emedicine.com article: Restraints, by Herbert Wigder, MD and Mary S Matthews, RN, BSN, JD