Editing Infection Control and Safety (section)

=== Safe application and monitoring ===

Apply the restraint over clothing or padding, never directly on bare skin over a bony prominence. Allow two fingers to slide between the restraint and the limb. Secure ties to the '''movable bed frame''', never to the side rails and never to a fixed part of the bed that would tighten when the bed is raised or lowered. Use a '''quick-release knot''', never a square knot or a bow that can tighten. Keep scissors accessible. In a wheelchair, secure to the frame behind the chair out of the patient's reach.

Monitoring for nonviolent restraint is typically every 2 hours, and for violent restraint every 15 minutes with continuous observation, per facility policy. At each check assess circulation, sensation, and motion distal to the device, skin integrity, respiratory status, and correct placement. '''Release the restraint at least every 2 hours''' to provide range of motion, reposition, toilet, offer fluids and nutrition, and perform skin care, and release one limb at a time in a violent patient. Never restrain a patient in the prone position or in any way that impedes breathing. Never leave a restrained patient alone with the restraint released. Document the behavior that necessitated the restraint, the alternatives tried and their results, the type and placement, the patient's response, all monitoring, and the criteria for discontinuation.

'''Application note.''' Restraint reduces agitation only in appearance. Restrained patients are at higher risk of pressure injury, aspiration, deconditioning, delirium, strangulation, and death. If an exam option offers a genuine alternative that would keep the patient safe, that option is almost always correct.