3. Be aware of risk factors that increase the danger of restraints: Some people are more at risk for restraint-related positional asphyxia than others. Risk factors include obesity; extreme physical exertion or struggling prior to, or during a restraint; heart disease; breathing problems, such as asthma or emphysema; and use of alcohol or drugs.
4. Monitor the person being restrained: Staff must be trained to watch for signs of distress from the individual being restrained. This can best be accomplished by assigning a staff member who is not directly involved in performing the restraint to monitor for signs of trouble, such as breathing difficulties. It’s important to note, however, that there are documented cases of individuals who have gone from a state of no apparent distress to death in a matter of moments. Monitoring the person’s status is not a substitute for avoiding high-risk positions that interfere with breathing.
5. Debrief: When restraints are deemed necessary, a debriefing process should follow so that staff can take a closer look at the circumstances before and during the restraint. What triggered the event? Could it have been prevented? Were any warning signs missed? Is there anything that could have been handled differently? The purpose of the debriefing is not to point fingers or place blame but to creatively consider alternatives that might prevent the next restraint.
Use Physical Techniques Sparingly on Abusive Individuals
Following these guidelines will reduce the risk of injury for everyone involved in a situation requiring the use of restraints. But the very best way to eliminate injuries due to restraint — both for staff and for the person being restrained — is to eliminate the need to restrain in the first place. Remember, the safest restraint is the one that doesn’t happen.
National Regulatory and Accrediting Organizations: Key Elements of Restraint-Related Standards
Centers for Medicare & Medicaid Services (CMS)
- Identifying events or factors that may trigger a need for emergency intervention
- Using nonphysical intervention skills
- Choosing least restrictive intervention based on patient’s condition or status
- Safe application of all types of restraints used at a hospital
- How to recognize and respond to signs of distress
Requires training to be ongoing. Training must be part of initial orientation and on a periodic basis thereafter
Joint Commission on Accreditation of Health Care Organizations (JCAHO)
Staff using restraint to manage assaultive or abusive behavior must be trained in the following areas:
- Identifying underlying causes of threatening behavior
- Understanding possible links between medical conditions and aggression
- Understanding how staff behaviors can affect patient behaviors and vice versa
- Use of de-escalation, mediation and other nonphysical techniques
- Recognizing signs of physical distress
in persons being restrained or seclud
Occupational Safety and Health Administration (OSHA)
Encourages hospitals to make a concentrated effort to reduce identified risks factors. These could include long waits; presence of gang members, people with substance abuse problems and distraught family members; and low staffing levels during times of increased activity
Judith Schubert is president of the Crisis Prevention Institute (CPI). For additional information on CPI, please visit www.crisisprevention.com.
View Part I and Part II of this series.
