Key Takeaways
- Restraints should only be used as a last resort after alternatives have failed
- Restraints carry serious risks including strangulation, circulation problems, and psychological harm
- A physician's order is required, and restraints must be the least restrictive effective option
- Check restrained patients every 15-30 minutes for circulation, skin, and comfort
- Document alternatives tried, reason for restraint, and all monitoring checks
Last updated: January 2026
Restraints and Alternatives
Restraints limit a patient's movement or access to their body. While sometimes necessary for safety, restraints carry significant risks and should only be used as a last resort after alternatives have failed.
Types of Restraints
| Type | Description | Examples |
|---|---|---|
| Physical restraints | Devices that limit movement | Wrist restraints, vest restraints, mitts |
| Chemical restraints | Medications that sedate | Sedatives given for behavioral control |
| Environmental restraints | Physical barriers | Locked units, bed rails (sometimes) |
| Seclusion | Isolated room | Locked room for patient isolation |
Physical Restraint Examples
| Restraint | Purpose | Risks |
|---|---|---|
| Wrist restraints | Prevent pulling at tubes/lines | Skin damage, circulation problems |
| Vest/jacket restraints | Prevent getting out of bed/chair | Strangulation risk |
| Mitts | Prevent scratching, pulling tubes | Skin breakdown |
| Lap belts | Keep patient in wheelchair | Sliding down, injury |
| Enclosed beds | Prevent falls | Psychological distress |
Dangers of Restraint Use
Restraints can cause serious harm or death:
| Risk | Description |
|---|---|
| Strangulation | Patient can become entangled and choke |
| Circulation problems | Too tight restricts blood flow |
| Skin breakdown | Pressure and friction cause wounds |
| Psychological harm | Fear, anxiety, agitation, depression |
| Loss of muscle mass | From immobility |
| Incontinence | Cannot reach bathroom |
| Aspiration | Cannot sit up properly |
| Death | From asphyxiation or cardiac events |
Legal and Regulatory Requirements
Restraints are heavily regulated by CMS (Centers for Medicare & Medicaid Services):
| Requirement | Details |
|---|---|
| Physician order | Required before restraint use |
| Time limit | Orders must be renewed regularly |
| Documentation | Every 15-30 minutes typically |
| Assessment | Regular checks for circulation, skin, positioning |
| Least restrictive | Use the least restrictive effective option |
| Release schedule | Regular release for movement, toileting, hydration |
| Alternative attempts | Must try alternatives first |
Alternatives to Restraints
Try alternatives BEFORE restraints:
| Alternative | Purpose |
|---|---|
| Frequent toileting | Address need to get up |
| Pain management | Reduce agitation from pain |
| Diversion activities | Redirect attention |
| Family presence | Calming influence |
| Low beds | Reduce fall injury risk |
| Bed alarms | Alert staff to movement |
| Wedge cushions | Help with positioning |
| Move patient closer | For better observation |
| Address causes | Hunger, thirst, discomfort |
| Calm environment | Reduce stimulation |
| Companion/sitter | Continuous observation |
| Investigate behavior | Find underlying cause |
If Restraints Are Used
CNAs must monitor restrained patients frequently (per facility policy, often every 15-30 minutes):
| Check | Description |
|---|---|
| Circulation | Color, temperature, pulse, sensation |
| Skin | Redness, breakdown, irritation |
| Position | Proper fit, not too tight or loose |
| Alignment | Body in safe position |
| Comfort | Need for repositioning, toileting |
| Hydration/nutrition | Offer fluids and food |
| Emotional state | Anxiety, distress |
| Release | Per schedule for movement |
Proper Restraint Application
If you must apply restraints (with physician order):
| Principle | Application |
|---|---|
| Correct size | Use appropriate size for patient |
| Proper fit | Two fingers should fit underneath |
| Quick release | Knot must be quick-release type |
| Secured properly | To bed frame, not side rails |
| Check frequently | As ordered, minimum q15-30 min |
| Document | All checks and findings |
Side Rails as Restraints
Side rails can be considered restraints if they prevent a patient who is oriented and capable from leaving bed:
| Situation | Restraint? |
|---|---|
| All 4 rails up on confused patient | Yes |
| 2 rails up for patient to turn | No |
| Rails up at patient's request | No |
| Rails used to entrap patient | Yes |
Documentation Requirements
| What to Document | When |
|---|---|
| Reason for restraint | Before application |
| Alternatives tried | Before restraint |
| Type of restraint used | At application |
| Physician order obtained | Before or immediately after |
| Regular checks performed | Every 15-30 minutes |
| Circulation, skin, position | At each check |
| Release for care | As performed |
| Patient response | Ongoing |
| Discontinuation | When removed |
Test Your Knowledge
What should be tried BEFORE using physical restraints?
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Test Your Knowledge
How often must restrained patients typically be checked?
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Test Your Knowledge
Which of the following is a serious risk of restraint use?
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D