Defining a Restraint by The Joint Commission
For healthcare organizations, The Joint Commission (TJC) provides a clear framework for identifying what constitutes a restraint. A restraint is defined as any method, chemical or physical, used to restrict a patient's freedom of movement for the purpose of managing their behavior. This applies across various clinical settings, including behavioral health and acute care hospitals. Any intervention that reduces a person's ability to move freely to manage their behavior is considered a restraint.
This broad definition includes actions and devices like the physical holding of pediatric patients, which must follow the same requirements as other restraints. Standards protect patient dignity, ensuring restraints are a last resort, used for the shortest duration, and never for coercion, discipline, or staff convenience.
Types of Restraints under Joint Commission Standards
Recognizing the specific type of restraint is the first step toward proper documentation, monitoring, and application.
Physical and Mechanical Restraints: These restrict movement using manual methods or mechanical devices. This can range from a staff hold to devices like soft wrist restraints. Bed side rails can also be restraints if they restrict movement and the patient cannot easily remove them. The context and the patient's ability to remove the device are key.
Chemical Restraints: This involves using medication to manage behavior or restrict movement, not as standard treatment. Examples include sedating an agitated patient when non-pharmacological methods are appropriate. Medications used as part of a standard treatment plan are not chemical restraints.
When is a device NOT considered a restraint?
Certain interventions are not classified as restraints. These include brief physical contact that a patient can easily escape, protective devices like orthopedic supports or surgical dressings, assisting a patient away from danger, and fall prevention measures for patients unable to exit the bed. However, if the intent of devices like side rails is to prevent voluntary exit, they are a restraint.
Comparison of Restraint Types and Exemptions
| Feature | Physical/Manual Restraint | Chemical Restraint | Exemptions (Not Restraints) |
|---|---|---|---|
| Method | Manual hold, mechanical device, material, or equipment | Medication used to restrict movement or manage behavior, not for standard treatment | Standard medical devices, brief and non-restrictive physical contact |
| Purpose | To immobilize or reduce the ability to move limbs, body, or head | To restrict freedom of movement or manage behavior via medication | Supportive care, fall prevention, routine exams, or patient-removable devices |
| Key Example | Wrist restraints, seclusion, manual holds | Use of a sedative to control agitation without a standard indication | Raised side rails for a patient unable to exit bed, orthotic devices |
| TJC Requirement | Strict protocols for application, monitoring, physician order, and documentation | Must be discontinued at the earliest possible time; not for convenience | No special TJC protocols required beyond standard care |
The Importance of Policy and Training
Understanding these distinctions is crucial for patient safety. TJC emphasizes clear policies, staff training, and continuous monitoring. Facilities must prioritize de-escalation and the least restrictive interventions. Restraints require an in-person evaluation within one hour of initiation and have strict time limits.
Conclusion
What is considered a restraint under Joint Commission Standards is any physical or chemical method used to restrict a patient's movement for behavioral management. This includes manual holds, mechanical devices, and medications for non-standard purposes. Certain supportive measures and standard medical devices are exempted. TJC standards protect patient rights and ensure restraints are used only as a last resort with robust monitoring and documentation.
Frequently Asked Questions
Q: What is the difference between a physical hold and a mechanical restraint under TJC standards?
A: A physical hold, or manual restraint, is hands-on control without a device, while a mechanical restraint uses a device to restrict movement. TJC now treats physical holding of pediatric patients with the same seriousness as mechanical restraints.
Q: Can a patient be given a medication to calm them down without a physician's order?
A: No. Medication used to manage behavior or restrict movement, not as standard treatment, is a chemical restraint. Chemical restraints require a physician's order and follow strict protocols.
Q: Is raising all four bed side rails always considered a restraint?
A: Not always; it's context-dependent. If they prevent voluntary exit, it's a restraint. If used to protect a patient unable to get out of bed from falling, it is not a restraint.
Q: Are orthopedically prescribed devices or surgical dressings considered restraints?
A: No, TJC excludes these as they are standard medical treatment.
Q: What is a key requirement for using restraints for violent or self-destructive behavior?
A: A face-to-face evaluation by a licensed practitioner is required within one hour of initiation for managing violent or self-destructive behavior. Restraint use must also be for the shortest possible duration.
Q: Is seclusion considered a type of restraint by TJC?
A: Seclusion is defined separately from restraint but is closely related and governed by similar strict TJC regulations. It involves isolating a patient in a room they cannot leave.
Q: Can restraints be used for staff convenience or as a form of punishment?
A: No. TJC standards explicitly prohibit using restraint for staff convenience, discipline, or retaliation. Use is limited to ensuring the immediate physical safety of the patient, staff, or others.
