Defining a Restraint in Healthcare
In healthcare, a restraint is any method that limits a person's movement or access to their own body and cannot be intentionally removed by them. Federal regulations, particularly from CMS, define restraints and require they only be used as a last resort for medical necessity. Restraints can be physical, chemical, or environmental.
Types of Restraints
Physical Restraints
Physical restraints include any manual or mechanical method or device restricting movement. A key aspect is the inability of the person to easily remove the device.
- Examples: Tied-down hand mitts, wheelchair seatbelts the person cannot unbuckle, and full bed side rails preventing exit are physical restraints. Other examples include tightly tucked sheets, lap trays, or positioning furniture to limit movement.
- Identification: Assess if a device restricts movement and cannot be removed by the person, regardless of intent.
Chemical Restraints
Chemical restraints are medications used to manage behavior or restrict movement, not for a diagnosed medical condition. Using medication for staff convenience is prohibited.
- Examples: Inappropriate use of psychoactive drugs like antipsychotics or benzodiazepines to sedate a patient for staff convenience constitutes a chemical restraint.
- Distinction: Medication for a diagnosed condition is not a restraint. Using the same medication solely for behavior control without a medical need is a chemical restraint.
Bed and Chair Alarms
Alarms are sometimes seen as alternatives but can be considered restraints.
- When Alarms are Restraints: If a resident fears moving due to the alarm, it restricts their freedom of movement and is a restraint. CMS notes position-change alarms can be restraints, especially if the noise is near the resident.
- Best Practices: Use alarms cautiously and ensure staff respond quickly. They should be part of a broader care plan, not the sole fall prevention method.
Alternatives and Dignity Promotion
Facilities must explore less restrictive interventions before using restraints. The aim is a safe environment respecting autonomy and dignity.
Comparison of Restrictive vs. Alternative Interventions
| Interventions | Examples | Purpose | Ethical Considerations |
|---|---|---|---|
| Restrictive | Tightly tied mitts, side rails up, lap belts | Restrict movement, prevent falls or dislodging of medical devices | Loss of dignity, physical harm, psychological trauma, violation of rights |
| Alternative | Increased supervision, low beds with floor mats, engaging activities, addressing unmet needs (pain, thirst) | Address root causes of behaviors, promote mobility, and enhance safety | Promotes resident dignity, autonomy, and emotional well-being |
Strategies to Avoid Restraint Use
- Assessment: Identify the cause of behaviors like agitation.
- Environment: Ensure a safe environment with good lighting and clear paths.
- Personalized Care: Use care plans based on resident routines and preferences.
- Staff Training: Train staff in de-escalation and restraint alternatives.
- Engagement: Offer activities to address boredom.
Ethical and Legal Considerations
Providers must protect residents while respecting their rights. The American Medical Association's Code of Ethics states restraints are a last resort, never for convenience. Facilities need documentation and monitoring for medically necessary restraint use.
Understanding the broad definition of a restraint ensures humane and respectful care. Consult the {Link: APNA https://www.apna.org/standards-of-practice-seclusion-and-restraint/} for more on ethical standards.
