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Restraint as a Last Resort

Restraint Planning

The RN collaborates with the Health Care Team to determine the restraint that is the least restrictive, safest, smallest dose (if deemed appropriate by authorized prescriber), for the shortest period of time (Choosing Wisely Canada Recommendations).

Restraint choice also:

  • Considers patient’s history, medical condition and symptoms
  • Allows patient to function at highest level (e.g. when providing care to patients exhibiting behaviours related to dementia or some other pathological cause, non-pharmacological interventions are to be trialed first)

Physical restraint in the form of mechanical devices must also comply with the infection control and safety standards outlined in the Restraint as a Last Resort Policy & Procedure (CL-SR-005). 

If the facility is unequipped with a suggested alternative or suggested restraint type (e.g. crash mat, hip protectors, chair alarm, low bed, alarmed seatbelt), a health care team member must ask the manager, team leader, administrator or other appropriate decision maker to purchase the proposed restraint alternative or restraint type. 

Types of Restraints

Definitions

Physical Restraint: 

Any action or procedure that prevents a person’s free body movement to a position of choice and/or normal access to their body by the use of any method, attached or adjacent to a person’s body, that they cannot control or remove easily (Bleijlevens, 2016). 

There are two subcategories of physical restraint:

  • Mechanical Device: Restraint by physical devices (e.g. wrist restraint)
  • Physical Intervention: Restraint using safe physical holding by another person (e.g. holding hand during blood draw in order to keep arm still)

NOTE If there is harm to the patient (e.g. bruising):

  • It must be documented in the patient's chart.
  • A SIMS report must be submitted.

 

Pharmacological (Chemical) Restraint:

A sedative or tranquillizer given to a patient to reduce agitation or potentially hazardous behaviour (Venes, 2017).

 

Environmental Restraint:

Predominantly used to prevent free movement of a person in a building/area, controlling a patient’s mobility (e.g. a secure unit or garden, seclusion or a time-out room) (RNAO, 2012).

 

References

Bleijlevens, M. H., Wagner, L. M., Capezuti, E., Hamers, J. P., & International Physical Restraint Workgroup. (2016). Physical restraints: consensus of a research definition using a modified Delphi technique. Journal of the American Geriatrics Society, 64(11), 2307-2310. DOI:10.111/jgs.14435
Registred Nurses' Association of Ontario. (2012). Best Practice Guideline: Promoting Safety: Alternative Approaches to the Use of Restraints. https://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints
Venes, D. (2017). Taber's cyclopedic medical dictionary (23. ed.). Retrieved from https://online.statref.com/Document.aspx?FxId=57&SessionID=2C6FA2CHLOTDOXVW