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Safe Use Of Restraints And Seclusion For Behavioral Management

What is a restraint?

A restraint is any method that limits your ability to move around freely or reach your normal body parts. Restraints can be used if your behavior (how you act) is out of control. This means you may hurt yourself or others. But, other things will be tried first before using a restraint.

What are the different kinds of restraints?

  • Physical restraints are when you are forced to stay in a chair or bed. This is done with special kinds of restraints placed on or near your body. These restraints cannot be easily removed by you. Following are some of the different kinds of physical restraints.
  • Fabric body holders
    • Belts put around your waist and connected to a bed or chair.
    • Cloth bands put around your wrists or ankles.
    • Cloth vests or "posey's" put around your chest.
    • Lapboards hooked to chairs that limit your ability to move.
    • Mittens placed on your hands.
  • Leather straps are placed around your wrists or ankles. These are used when fabric restraints may not be strong enough and your behavior is out of control. These restraints may be locked. The keys for these restraints are always kept with your caregivers in case they need to be removed quickly. A strong pair of scissors are also kept near so the restraints can be cut off in an emergency.
  • Chemical restraints are medicine used to help you calm down and relax when you may hurt yourself or others. This medicine is not the regular medicines you may take every day for your medical or emotional problems.

What is seclusion?

Seclusion is when you need to be locked in a safety room because you are out of control. The door is locked because you will not stay in the room. Caregivers will closely watch you while you are in seclusion. You may come out of seclusion when caregivers feel you will not hurt yourself or others.

What do I need to know about restraints or seclusion?

The caregivers will do a complete assessment on you when you are treated for a mental health problem. A complete assessment includes talking about your medical conditions, your medicines, and a physical check up. This will help caregivers decide what type of care is best for you. Following are things caregivers will talk to you and your family about restraints and seclusion.

  • Ways that can help you control your behavior early so restraints or seclusion will not be needed.
  • Medical, physical, and other problems that might put you at greater risk if restraints or seclusion were used.
  • Information about using restraints and seclusion at this healthcare facility.
  • The role of the family. This includes being called if you were placed in restraints or seclusion.

Why do I need restraints or seclusion?

  • Behavior reasons: You may need restraints or seclusion because your behavior is out of control. This means you may hurt yourself or others. Other ways, such as talking to you in a calm voice or taking away unsafe things may be tried first. Restraints or seclusion should never be used to punish you. And restraints should not be used to make it easier for caregivers to take care of you.
  • Medical or surgical reasons: Restraints may be used for medical or surgical reasons. You may need wrist restraints to keep you from pulling out tubes. Or, you may need restraints to help you stay still during or after a procedure. Ask caregivers for the CareNotes™ handout about safe use of restraints for medical reasons.

What are the risks of using restraints or seclusion?

  • Elimination problems: You may become constipated. (unable to have a BM.) because you couldn't drink enough liquids or move around enough. Or, you can become incontinent (in-kon-tih-nent) which means loosing bowel and bladder control if you are in restraints. This may happen because the restraints did not allow you to get up to use the toilet when needed. Always call your caregiver if you have to go to the bathroom.
  • Injury problems: Severe injuries have been caused by restraints when they are not used correctly. You could get caught in the restraint, choke and die if the restraints are put on wrong. You may become more upset or out of control than before the restraints were used. You may also fight against the restraints. Fighting to get out of the restraints can cause very bad falls and injuries. Always call your caregiver if you need help or if you are afraid.
  • Lung problems: You may be more likely to get pneumonia (lung infection). This is caused by not moving around enough and breathing deeply. Swallowing your secretions (spit) into your lungs or choking on food or liquids can also cause lung problems.
  • Mental problems: Restraints may cause you to feel you are being punished. You may be afraid that you will not be able to get help in an emergency. You can become depressed. Restraints can bring back the feelings of being abused if you have been abused on the past. Being restrained can also be embarrassing. You may become more confused and need more help to do things you use to do on your own.
  • Nutritional problems: You may not feel like eating or drinking as much if you are in restraints You may need someone to help you eat or drink. You may become weak and low on body fluids if you do not eat or drink enough.
  • Physical problems:
    • Bone strength may decrease because of less activity if you are in restraints for a long time. This can lead to bone fractures.
    • Muscles can contract (tighten) and shrink if you cannot move freely. This can make you weak and have pain when you move.
    • Skin can break down and cause sores if you do not move enough. These sores may happen under the restraints and on other parts of the body.
    • Blood flow can decrease to the area under the restraints if they are too tight. This can cause long-term damage to muscles and nerves if blood flow is cut off by the restraint.
    • Blood clots can form and cause blood flow problems to important body parts, like your lungs or brain.

What are the safety issues when using restraints or seclusion?

Restraints can be very dangerous if not used correctly. So, caregivers will try other ways to make sure you are safe before using restraints or seclusion. Talk to your caregivers if you have questions about your care and the need for restraints or seclusion. These following safety issues will be done if you need restraints or seclusion.

  • Doctor's order: Your doctor must order restraints or seclusion. The written order will tell the caregivers what type of restraint to use. The order also says how long they will be used and when they can be removed. A doctor will come in and check on you when you have been put in restraints or seclusion. Restraints or seclusion should only be used for a short time. And, restraints or seclusion are used only after other things have been tried to keep you safe
  • Family: Your family will be called, around the time you are put in restraints or seclusion. This is done only if you and your family had both agreed to have your family called.
  • Caregiver safety checks: Caregivers are specially trained in how to care for patients in restraints or in seclusion. Caregivers will check on you often to make sure you are safe and all your needs are met. Following are the safety checks that caregivers will do while you are in restraints.
    • Check that the restraint is the right size. Also if they are put on correctly.
    • Check that the restraints are tied to the part of the bed that moves with you if an electric bed is used. This keeps the restraint from getting too tight or too loose as the head or foot of the bed is moved.
    • Check to make sure a slipknot was used if cloth or vest restraints are used. A slipknot can be quickly untied in an emergency. The restraint will be tied to the bed frame or back of the wheelchair where the straps cannot be reached. The restraints should not be tied to the side rail. The restraint could be pulled too tight if the side rail is put down.
    • Check to make sure the key is near at all times if leather restraints are used.
    • Check your skin often to make sure the restraints are not causing sores or bruising.
    • Check your ability to move and change your position often.
    • Caregivers will give you fluids to drink and food to eat. They will help you eat and drink if the restraints keep you from doing it yourself. And, you will be helped to the toilet at regular times.
    • Check your vital signs. This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). Caregivers may listen to your heart and lungs by using a stethoscope (steth-uh-skop). Your vital signs are taken so caregivers can see how you are doing.
    • Check that you have no pain or discomfort while you are in restraints or seclusion.
    • Check on you to see if restraints or seclusion are still needed. Have you calmed down? Is your mind clearer? How are you reacting to the restraints? Are you yelling or fighting to try to get out of the restraints? You will be released from the restraints or seclusion as soon as your behavior is not harmful to yourself or others.

Care Agreement

  • You have the right to be free any time from restraints unless medically needed. You also have the right to safe care and to be treated with respect when restraints or seclusion are used. Restraints or seclusion should not cause you pain or harm.
  • You have the right to help plan the care for yourself. To help with this plan, you and your family must learn about your illness and when you need restraints. Ask if you or your family can come to the caregiver team meeting to discuss your care and need for restraints. You can then discuss the treatment options with caregivers. You can work with them to decide what care will be used to treat you.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.