Editing Management of Care (section)

=== Restraints ===
Restraints are a last resort. Less restrictive alternatives must be tried and documented first: reorientation, bed and chair alarms, moving the patient nearer the nurses' station, involving family, toileting schedules, addressing pain, hunger, and delirium triggers, and removing lines and tubes when no longer needed.

Rules that appear repeatedly on examinations:
* A '''provider order is required'''. In an emergency an RN may initiate restraint and must obtain the order promptly per policy.
* '''PRN or standing orders for restraints are prohibited.'''
* Orders for restraint of '''violent or self-destructive''' behavior are time-limited and must be renewed within maximum intervals: 4 hours for adults 18 and older, 2 hours for ages 9 through 17, and 1 hour for children under 9 (Centers for Medicare & Medicaid Services [CMS], 2020).
* A '''face-to-face evaluation''' of the patient is required within 1 hour of initiating restraint for violent or self-destructive behavior.
* Use the '''least restrictive''' effective device, apply it so it can be released quickly, secure ties to the '''movable part of the bed frame''', never to the side rail, and use a '''quick-release knot'''.
* Monitor circulation, sensation, and skin integrity; release and provide range of motion, repositioning, toileting, and fluids per policy, commonly every 2 hours.
* Assessment, alternatives attempted, patient response, and continued need must be documented.