Friday Factoid: To Restrain or Not Restrain? That is the Question.

For more than three centuries, physical restraints have been utilized to manage psychiatric patients (as cited in Allen et al., 2018). However, despite increased regulatory pressure and legal action being taken regarding its use, the practice of using physical restraints to prevent patients from harming themselves continues to prevail in acute psychiatric settings (Allen et al., 2018). Physical restraints, according to the Centers for Medicare and Medicaid Services (CMS) are defined as “any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident’s body” which restricts an individual’s freedom to move or have normal access to his or her body (as cited in Allen et al., 2018, p. 1).

Conducting a systematic review of the literature, Allen et al. (2018) identified various methods that could be used to decrease the use of physical restraints on acute psychiatric inpatients. Multiple alternative interventions that could be implemented were identified. These methods included using de-escalation techniques taught to hospital personnel, implementing debriefings following restraint episodes, and employing individualized or patient-specific crisis management plans or tools (Allen et al., 2018). Other methods that were identified included encouraging increased reporting and data sharing, implementing the use of restraint chairs, and forming a team of crisis responders along with instituting a formal policy change which necessitated prior authorization being attained to apply restraints from the chief medical officer (Allen et al., 2018). Utilization of these alternative approaches were shown to substantially decrease the rate of restraints over the course of a 2 to 3-year period. For example, Bell and Gallacher reported a 50% decrease in the hours of restraint use per 1,000 patient bed days, whereas Godfrey et al. (2014) reported a 98% decrease during a 3-year study (as cited in Allen et al., 2018).

References

Allen, D. E., Fetzer, S., Siefken, C., Nadler-Moodie, M., & Goodman, K. (2018). Decreasing physical restraint in acute inpatient psychiatric hospitals: A systematic Review. Journal of American Psychiatric Nurses Association, 1-5. doi: 10.1177/1078390318817130

Shirreka Mackay, LPC
WKPIC Pre-Doctoral Practicum Student

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