Applying a Waist Restraint

Goal: The patient is constrained by the restraint, remains free from injury, and the restraint does not interfere with therapeutic devices.

1. Determine need for restraints. Assess patient’s physical condition, behavior, and mental status. (Refer to Fundamentals Review 3-1, 3-2, 3-3, and 3-4 at the beginning of the chapter.)

2. Confirm agency policy for application of restraints. Secure an order from the primary care provider or validate that the order has been obtained within the past 24 hours.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Explain reason for use to patient and family. Clarify how care will be given and how needs will be met. Explain that restraint is a temporary measure.

6. Include the patient’s family and/or significant others in the plan of care.

7. Apply restraint according to manufacturer’s directions:
a. Choose the correct size of the least restrictive type of device that allows the greatest possible degree of mobility.
b. Pad bony prominences that may be affected by the waist restraint.
c. Assist patient to a sitting position, if not contraindicated.
d. Place waist restraint on patient over gown. Bring ties through slots in restraint. Position slots at patient’s back.
e. Pull the ties secure. Ensure that the restraint is not too tight and there are no wrinkles in it.
f. Insert fist between restraint and patient to ensure that breathing is not constricted. Assess respirations after restraint is applied.

8. Use a quick-release knot to tie the restraint to the bed frame, not side rail. If patient is in a wheelchair, lock the wheels and place the ties under the arm rests and tie behind the chair. Site should not be readily accessible to the patient.

9. Remove PPE, if used. Perform hand hygiene.

10. Assess the patient at least every hour or according to facility policy. An assessment should include the placement of the restraint, respiratory assessment, and skin integrity. Assess for signs of sensory deprivation, such as increased sleeping, daydreaming, anxiety, panic, and hallucinations.

11. Remove restraint at least every 2 hours or according to agency policy and patient need. Perform ROM exercises.

12. Evaluate patient for continued need of restraint. Reapply restraint only if continued need is evident and order is still valid.

13. Reassure patient at regular intervals. Provide continued explanation of rationale for interventions, reorientation if necessary, and plan of care. Keep call bell within easy reach.

14. Perform hand hygiene.