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The Different Types of Medical Restraints

August 30, 2024 9:00 AM
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    Understanding the Need for Medical Restraints

    The use of medical restraints in professional healthcare settings is sometimes necessary to help ensure patient safety. Medical restraints can also be used to protect the safety of caregivers and other staff members, as well as other patients and visitors.

    Medical restraints, regardless of type, are intended for use only as a last resort to prevent patients from harming themselves and/or to prevent them from harming others. It should be noted, of course, that using any type of restraint for punishment or for caregiver convenience is never permissible. Medical restraints are intended solely to help safeguard patients and/or those around them. Restraint use should be discontinued immediately once it is safe to do so.

    Nurses should receive comprehensive, up-to-date training on the appropriate use of patient restraints. It is imperative that these frontline medical professionals possess a full understanding of both how and when to use restraints, so they are capable of doing so in an effective, ethical, and lawful manner.

    Determining When To Use a Restraint

    slh-restraints-content-1-determining-when

    The patient’s present behavior determines if the use of a restraint is warranted. The U.S. Centers for Medicare and Medicaid Services (CMS) defines two different types of behavior that could warrant the use of restraint or seclusion: non-violent, non-self-destructive (NVNSD) behavior and violent, self-destructive (VSD) behavior.1

    Restraints should never cause harm. If the use of a restraint is deemed necessary, the least restrictive effective measure should be applied. The patient’s condition must always be taken into consideration when making restraint-related decisions.

    Hospitals and other healthcare facilities are expected to adhere to applicable guidelines and standards published by federal and state governing agencies (e.g., CMS1) and accrediting organizations (e.g., The Joint Commission, TJC2).

    Now, let’s look at the categories into which medical restraints are commonly grouped.

    Categories of Medical Restraints

    Medical restraints are typically classified as being either a physical restraint or a chemical restraint. Seclusion represents a third form of restraint.

    • Physical restraint ― Interventions or devices that prevent the patient from moving freely or that restrict the patient’s normal access to their own body; physical restraint is the most frequently employed form of restraint.3
    • Chemical restraint ― Utilization of a drug to restrict the movement or behavior of the patient (where the drug/dosage is not an approved standard of treatment for the patient’s condition); many healthcare facilities do not allow medications to be used for chemical restraint.3
    • Seclusion ― Isolating the patient in a room involuntarily and preventing them from exiting.3


    The remainder of this article will focus on several different types of physical restraint devices available for use in hospitals and other healthcare facilities.

    Physical Restraints and Restraint Alternatives

    It is important for healthcare professionals to have a solid working knowledge of their own facility’s “least restrictive to most restrictive” spectrum of available physical restraints and restraint alternatives (see the example provided). When restraint use is warranted, the least restrictive potentially effective measure should be considered first. Only if this option proves insufficient should more restrictive options be considered incrementally.

    The following sections briefly describe several different types of patient restraint devices and restraint alternatives.

    Amazon Product Image-posey-restraints-least-to-most-graphic

    Vest Restraints

    Vest restraints are designed to help prevent unassisted wheelchair, bed, and stretcher exits. Considered one of the more physically restrictive types of patient restraints available for professional use, these sleeveless garment-style devices can be secured to a wheelchair, bed, or stretcher as indicated.

    Limb Restraints

    Limb restraints (limb holders) are also considered to be among the more physically restrictive devices available to healthcare professionals. They are designed to limit the movement of wrists and/or ankles in patients assessed to be at risk of disrupting life-saving treatment, pulling lines/tubes, exacerbating skin conditions, compromising wound site integrity, or self-injury.

    Sometimes these devices are referred to as being either soft restraints or hard restraints, depending on specific features such as cuff and strap materials and whether or not they can be locked. Limb holders are designed for attachment to a bed or stretcher as indicated.

    Enclosure Beds

    Enclosure beds are designed to provide a safe, controlled environment for patients at risk of injury from an unassisted bed exit. Use of enclosure beds can help eliminate the need for more restrictive devices like limb holders or vest restraints.

    Belt Restraints / Restraint Alternatives

    Belts are designed for use with patients who need a reminder to call for assistance before exiting a hospital bed or wheelchair, for limiting unassisted exit and unwanted movement, or for patients who require a positioning device for added safety or to assist medical treatment.

    Belts can be made from a variety of materials, can offer locking capabilities, and can be designed specifically to allow patients to self-release. Related medical devices include straps, wraps, torso supports, and pelvic holders. Belts and similar medical devices can be attached to a hospital bed, wheelchair, stretcher, chair, OR table, exam table, or treatment table as indicated.

    A belt’s specific features help determine if it is considered a less restrictive or more restrictive device. In some states and facilities, belts are not considered restraints.

    Hand Mitts

    Mitts are designed to help protect patients who are prone to disrupting medical treatment or to self-harm. Mitts hinder picking and tube pulling. Their construction and padding varies, as does the level of hand visibility afforded and the degree of finger movement permitted. Mitts that include an inspection flap allow caregivers quick access to the patient’s hand.

    Mitts are generally considered to be less physically restrictive devices, and in some states and facilities they are not considered restraints.

    Arm Sleeves

    Multipurpose sleeves are designed to limit or minimize patient arm movements without the use of rigid splints. Multipurpose sleeves are in the least restrictive device category, and in some states and facilities they are not considered restraints.

    De-escalation and Diversion

    Healthcare professionals should remember that whenever possible, de-escalation techniques and diversionary devices should be tried before the decision is made to use any type of restraint.

    Diversionary devices such as activity aprons and fidget sensory aids, for example, are designed to provide stimulating activities and textures for patients with decreased cognitive function and/or requiring tactile stimulation. Additionally, some mitts are designed with bead fillings for use as diversionary devices.

    Contact us today to learn more about medical restraints and restraint alternatives.

    References:

    1. U.S. Centers for Medicare and Medicaid Services. www.cms.gov.

    2. The Joint Commission. www.jointcommission.org. 

    3. American Nurse Today (G. Springer), When and how to use restraints, Volume 10, Number 1. www.myamericannurse.com/use-restraints. Published: 13 January 2015. Accessed: 29 May 2024.

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