Chemical and physical restraints: What are the rules?

The appropriate use of patient restraints in health care settings can keep both patients and hospital staff safe from injury, but they are often overused and abused. It’s important to know what the standard of care requires and what rights a patient has when it comes to restraints, be they physical or chemical.

Here are just two examples of why understanding the rules around restraints is important to everyone’s safety.

Earlier this year, a woman seeking drug treatment was taken to a hospital in Illinois. She had drugs in her system and was combative, so the hospital staff tied her to a bed by her wrists and ankles and gave her sedatives. A nurse later found her unresponsive. The woman was resuscitated and the hospital became the subject of an investigation by Illinois public health officials.

Also this year, a man who had been arrested was brought to a hospital because he had injured himself. Agitated and angry, he smashed a cellphone that a nurse had handed him to call someone, and then struck the nurse. He had to be put into restraints for everyone’s safety.

All of this is to say that hospitals have become dangerous workplaces, and sometimes it’s necessary to restrain individuals to keep them from getting hurt or doing harm to others. It becomes inappropriate, however, when a patient is physically or chemically restrained because the facility is understaffed and doesn’t have the time or patience to deal with disruptive patients.

Types of restraints include belts, vests, jackets and mitts for the patient's hands, as well as devices to prevent movement of elbows, knees, wrists and ankles. Other forms of restraint are:

• Holding a patient to restrict movement.

• Being given medication to restrict movement.

• Placing a person in a room alone, from which they are not free to leave (seclusion).

Restraints have their uses. You certainly don’t want to be at risk of falling off a stretcher during transport, and you may need to be held in a certain position during surgery. Patients who are agitated or confused, which often happens in the intensive care unit, can become combative and a danger to themselves and others.

Restraints should not cause harm or be used as punishment, however. Health care providers should first try other methods to control a patient and ensure safety and employ restraints only as a last resort.

In Illinois, hospitals and nursing homes are required to obtain the informed consent of the individual or their caregiver before using restraints, except in emergency situations. Even in an emergency, though, their use must be justified and documented. A physician has to be involved in ordering restraints, and staff must be trained in how to use them. The least restrictive method must be used; there has to be regular reassessment; and the restraints have to be removed as soon as it’s safe for the patient and caregivers.

The use of chemical restraints without proper justification is generally prohibited. It’s not appropriate to give these drugs to dementia patients with no history of psychotic behavior. Older people in the hospital who get sleep deprived may act psychotic, but those strong medications have serious side effects.

The standard of care requires that individuals:

• Can have a bowel movement or urinate.

• Are kept clean.

• Get the food and fluids they need.

• Are as comfortable as possible.

• Do not injure themselves.

Patients who are restrained also need to be monitored to make sure their blood flow isn’t being impeded. Again, it’s important to have restraints removed as soon as it’s safe for everyone to do so.

If you are not happy with how a loved one is being restrained, or you feel the standard of care isn’t being met, talk with someone on the medical team or the hospital ombudsman. A patient advocate can also be helpful in this situation, as they can review the medical records, documentation and restraints being used to make sure their use is justified and safe.

Complaints can be filed with the Illinois Department of Public Health; visit idph.illinois.gov to find out how. The Joint Commission (jointcommission.org), the agency that oversees how hospitals are run in the U.S., is another good source of information about the standard of care regarding restraints.

Used correctly and occasionally, restraints are important tools for the safety of patients and health care providers. “Correctly” and “occasionally” are the keys.

• Teri (Dreher) Frykenberg is a board-certified patient advocate. A critical care registered nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Her book, “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” is available on Amazon. She is offering a free phone consultation to Daily Herald readers; email her at teri@northshorern.com.