A hospital's decision to use restraints on patients is a difficult one, involving complex issues which can pose significant risks to a hospital. A hospital may be sued for negligence for not taking adequate precautions to protect impaired, elderly, incapacitated or unstable patients. On the other hand, hospitals also have been sued for false imprisonment when patients were restrained against their wishes.
Federal Medicare regulations and policies, as well as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), impose restrictions on how facilities may use physical or chemical restraints. Most states also have laws regarding patient restraints. Although the statutes differ slightly from state to state, such laws generally require the restraint to be:
- Authorized in writing by a physician.
- Used for only a specified period of time.
- Applied only by a physician or other qualified licensed nurse or personnel under the supervision of the physician.
The liability risk in using restraints can be reduced significantly if the hospital has a written policy that is stated clearly and followed consistently. A written policy helps hospital personnel understand when restraints can and cannot be used. Any adopted policy should:
- Strike a good balance between the need for the judicious use of restraints to protect the patient from injury and the avoidance of the misuse or overuse of such restraints.
- Provide that restraints be used sparingly and only when no less restrictive means is available.
- Never be used for a period greater than 24 hours without the attending physician's reassessment of the patient's condition and need for further restraint.
- Prohibit the use of PRN or as-needed patient restraint orders.
- Require the physician to make the determination a restraint is needed. If an oral order is the basis of the restraint, the physician should evaluate the patient and sign the order within 24 hours. In all cases, the physician should certify in writing that the patient's life or health could be seriously jeopardized unless restraints are used, and that no less restrictive alternative is realistically possible.
A patient should never be restrained solely for the convenience of the hospital staff or as punishment. Such punitive or convenience restraint use is prohibited expressly by most state laws, Medicare regulations and JCAHO standards.
Liability risk for restraint use can be further reduced by having the incompetent patient's guardian or family member sign a release form:
- Restraint FormAgreement Regarding the Use of Restraints
Patient Name ________________________________________________
Dr. ______________________ has recommended temporary use of physical restraints for the above-named patient. The recommended restraints include:
The attending physician has determined that restraints are necessary to provide appropriate medical treatment for the patient's current medical condition. They are not being recommended for the purpose of discipline or for the convenience of the facility or its staff. Furthermore, the attending physician has determined that no less restrictive intervention is available that would adequately serve to meet the patient's current medical needs.
If you do not want physical restraints to be used, the attending physician may require that you arrange, at your own expense, for a full-time, trained personal sitter who can monitor the patient at all times and restrain and protect the patient when necessary so appropriate medical treatment may continue to be provided. This facility provides 24-hour skilled nursing care and support services as required by Medicare and all applicable licensure programs. However, staff members are not able to continuously monitor or restrain each patient at all times. Initial one of the following options and sign below:
______ I hereby CONSENT, on behalf of the patient, to the temporary use of the physical restraints recommended by the patient's attending physician. I understand the restraints will be removed as soon as the patient's medical condition no longer requires their use.
______ I hereby REFUSE, on behalf of the patient, the temporary use of the physical restraints recommended by the patient's attending physician. On behalf of myself and the patient, I hereby release, hold harmless and agree to indemnify the attending physician, this facility and their employees, officers, directors, agents and representatives of any and all liability for any damages or injuries to the patient or to other persons arising as a result of not using the recommended temporary restraints. Furthermore, upon request of the attending physician, I agree to arrange for a personal sitter to provide continuous observation and restraints for the protection of the patient.
SIGNED: __________________________________ Date: _____________
RELATION TO PATIENT: _______________________________________
WITNESS: _________________________________ Date: _____________