Physical restraints are often used in the hospital when older patients are unsteady and at risk of falls.

Extensive research has shown that physical restraints don’t decrease the risk of falling and restraints can cause serious injuries. Patients have injured themselves struggling against restraints or when entangled by restraints after getting partway out of bed. Death has resulted. Restraints delay recovery, cause de-conditioning, and create psychological trauma. To understand this better, try being tied up for a while.

Some hospitals and nursing homes are entirely restraint-free! Reduced restraint use is also an important quality indicator.

One problem that we all face is limited resources. Under ideal circumstances, one way to reduce restraints is to provide closer observation by nurses, which is not always practical. However, there are strategies that may work for you. Sometimes simple things make a big difference.

First, get patients out of bed, and consider which of the lines and tubes are really essential. Often we keep IV lines and Foley catheters in patients longer than we really need them. Can the IV be removed or converted to a saline lock? Could the patient be managed with diapers and daily weights (to track volume status) in place of a Foley catheter? Scheduled toileting improves mobility and decreases incontinent episodes (and bed changes). Getting out of bed may also improve eating, and bowel function, and lessen the need for NG tubes.

When restraints are used to keep patients from getting out of bed unassisted and injuring themselves, try to determine what patients are seeking. Using the bathroom, or getting food or water are common goals. If we meet those needs, the restraints often may be safely removed.


Environmental changes can also make a difference. Some patients do better when they are out of their rooms or have more frequent social interaction during the day. Television and radio noises help when lying in bed, but this can become boring. Moving people closer to the nursing station, getting them up in chairs in the hallway, and having friendly visitors can really help.

• Get patients out of bed
  
  
• Remove IV and foley as early as possible
  
  
• Find out what patients need or want:
  • food
  • water
  • bathroom
    
    
• Check for and treat obstipation and pain
  
  
• Get patients out of rooms
  • move closer to nursing station
  • visit frequently
  • increase socialization and stimulation during the day