June 6, 2017 | Health System Risk Management


The use of restraints has the power to humiliate, terrify, injure, or even kill an individual.1 Deaths caused by the use of restraints may occasionally draw the public's attention, but innumerable sad accounts of individuals being restrained never reach news headlines. In a classic study on the subject of restraints conducted by Strumpf and Evans, one patient said, "I felt like a dog and cried all night. It hurt me to have to be tied up. I felt like I was nobody, like I was dirt. It makes me cry to talk about it." Another patient stated, "I felt like I was nailed to a cross," while another asked, "If there was a fire, how would I get out?"2

Restraint use has been found to have a number of detrimental psychological and physical effects on patients, including the following5:

While the restrained individual bears the brunt of risk and pain caused by restraint use, family members and staff are deeply affected as well. Family members who discover their loved one in restraints have reported feelings of hopelessness and anger and distrust of nursing staff.1 Staff members who must use restraints report feelings of sadness, guilt, and pity for the restrained person.6

Restraint and seclusion are among the most common reasons hospitals are cited by CMS.3 For example, CMS's 2016 fourth-quarter deficiency report revealed nearly 2,000 instances in which hospitals were cited by CMS for violations related to restraint and seclusion.4 In addition, the improper use of restraints can lead to expensive lawsuits and negative publicity.

National and state efforts to pass restraint reduction legislation and to educate facility administrators on the dangers of restraint use in the 1990s and early 2000s appear to have had an effect on reducing restraint use. For example, between 1993 and 2003, Pennsylvania state hospitals saw the number of hours that mechanical restraints were used on patients drop from 11,000 to just over 90.7 However, several more recent studies suggest that restraint use is still prevalent in U.S. hospitals, particularly in psychiatric units and intensive care units (ICUs). For example:

To reduce the risk of psychological and physical injury posed by restraints, and to comply with Joint Commission standards and CMS regulations, facilities must ensure that restraints...

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