Implementing Alternatives to the Use of Restraints

Goal: The use of restraints is avoided and the patient and others remain free from harm.

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

2. Identify the patient.

3. Explain the rationale for interventions to the patient and family/significant others.

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

5. Identify behavior(s) that place the patient at risk for restraint use. Assess the patient’s status and environment, as outlined above.

6. Identify triggers or contributing factors to patient behaviors. Evaluate medication usage for medications that can contribute to cognitive and movement dysfunction and contribute to increased risk for falls.

7. Assess the patient’s functional, mental, and psychological status and the environment, as outlined above.

8. Provide adequate lighting. Use a nightlight during sleeping hours.

9. Consult with primary care provider and other appropriate healthcare providers regarding the continued need for treatments/therapies and the use of the least invasive method to deliver care.

10. Assess the patient for pain and discomfort. Provide appropriate pharmacologic and nonpharmacologic interventions. (Refer to Chapter 10, Comfort.)

11. Ask a family member or significant other to stay with patient.

12. Reduce unnecessary environmental stimulation and noise.

13. Provide simple, clear, and direct explanations for treatments and care. Repeat to reinforce as needed.

14. Distract and redirect using a calm voice.

15. Increase the frequency of patient observation and surveillance; 1- or 2-hour nursing rounds, including pain assessment, toileting assistance, patient comfort, personal items in reach, and patient needs.


16. Implement fall precaution interventions. Refer to Skill 3-1.

17. Camouflage tube and other treatment sites with clothing, elastic sleeves, or bandaging.

18. Ensure the use of glasses and hearing aids, if necessary.

19. Consider relocation to a room close to the nursing station.

20. Encourage daily exercise/provide exercise and activities or relaxation techniques.

21. Make the environment as homelike as possible; provide familiar objects.

22. Allow restless patient to walk after ensuring that environment is safe. Use a large plant or piece of furniture as a barrier to limit wandering from designated area.

23. Consider the use of patient attendant or sitter.

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