Pathophysiology
Clinical meaning
Physical restraints are devices that restrict a patient's movement and are used only as a LAST RESORT when less restrictive interventions have failed and the patient poses an immediate risk of harm to self or others. Restraint use is heavily regulated by CMS, The Joint Commission, and state laws due to the significant risks: injury from struggling, skin breakdown from pressure, neurovascular compromise, aspiration (especially in supine patients), respiratory compromise (vest restraints), strangulation, psychological trauma, and death. Restraints are classified as: limb restraints (wrist/ankle), vest/jacket restraints, mitt restraints, and seclusion (behavioral). The least restrictive device must be used for the shortest duration necessary. Restraints require a physician/provider order BEFORE or WITHIN 1 hour of application (for emergency situations). Orders must be time-limited: behavioral health restraints require renewal every 4 hours for adults, every 2 hours for ages 9-17, every 1 hour for children under 9. Medical-surgical restraints require renewal per facility policy (typically every 24 hours). The patient in restraints must be assessed regularly (at minimum every 2 hours) for circulation, sensation, movement (CSM checks), skin integrity, and basic needs...