- Prior to placing a patient in restraints, complete a comprehensive assessment in an effort to identify potential causes for the behavior that is creating the need for the restraint. Address any unmet needs or physiological imbalances. A comprehensive assessment includes:
- Health history
- Medication usage
- Functional status
- Ability to communicate
- Substance abuse
- Psychiatric illness
- Emotional status
- Environment (noise, lighting, barriers to mobility)
- Attempt to use least restrictive alternatives, when possible. Examples of least restrictive alternatives include alarms, low beds, and skin sleeves. If these alternatives are ineffective, a restraint may be necessary.
- Educate the patient on why you are placing the restraint, and what they need to do to have it removed. Promptly notify the family.
- Remove the restraints as early as possible.
- Report the death of a patient who has been in restraint/seclusion within 24 hours.
- The only exceptions to the 24 hour reporting requirement are patients who have non-rigid, cloth-like materials applied to the upper extremities (mitts, soft or neoprene wrist restraints, or elbow immobilizers).
- Report any death that occurs within 1 week after restraint or seclusion is removed, where it is reasonable to assume that use of the restraint or placement in seclusion contributed directly or indirectly to a patient's death. "Reasonable to assume" in this context includes, but is not limited to, deaths related to restrictions of movement for prolonged periods of time, restriction of breathing or compression of the chest, or asphyxiation.
- All reportable deaths should be communicated to Compliance and Risk Management. For inpatients, the form is available in Health Link. For outpatients, fax the Form “Report of Death”(UWH4009322) to Compliance at (608) 203-4544 and Risk Management at (608) 263-9830. Contact the Nursing Coordinator with any questions.
Restraints (Nursing Practice Guideline)