focus on... safe use of restraints

Focus on... Safe Use of Restraints

This Focus On... section of American Nurse Today wasfunded by an unrestricted educational grant fromPosey Co. Content was developed independently ofthe sponsor and all articles have undergone peerreview according to American Nurse Today standards.

26 American Nurse Today Volume 10, Number 1 www.AmericanNurseToday.com

Few things cause as much angstfor a nurse as placing a patientin a restraint, who may feel his

or her personal freedom is beingtaken away. But in certain situa-tions, restraining a patient is the on-ly option that ensures the safety ofthe patient and others.

As nurses, we’re ethically obli-gated to ensure the patient’s basicright not to be subjected to inap-propriate restraint use. Restraintsmust not be used for coercion,punishment, discipline, or staff con-venience. Improper restraint usecan lead to serious sanctions by thestate health department, The JointCommission (TJC), or both. Use re-straints only to help keep the pa-tient, staff, other patients, and visi-tors safe—and only as a last resort.

Categories of restraints Three general categories of re-straints exist—physical restraint,chemical restraint, and seclusion.

Physical restraintPhysical restraint, the most fre-quently used type, is a specificintervention or device that preventsthe patient from moving freely orrestricts normal access to the pa-tient’s own body. Physical restraintmay involve:• applying a wrist, ankle, or waist

restraint• tucking in a sheet very tightly so

the patient can’t move• keeping all side rails up to pre-

vent the patient from getting outof bed

• using an enclosure bed. Typically, if the patient can easily

remove the device, it doesn’t qualifyas a physical restraint. Also, holdinga patient in a manner that restricts

movement (such as when giving anintramuscular injection against thepatient’s will) is considered a physi-cal restraint. A physical restraintmay be used for either nonviolent,nonself-destructive behavior or vio-lent, self-destructive behavior. (SeeWhat isn’t a restraint?)

Restraints for nonviolent, non-self-destructive behavior. Typically,these types of physical restraints are nursing interventions to keepthe patient from pulling at tubes,drains, and lines or to prevent thepatient from ambulating when it’sunsafe to do so—in other words, toenhance patient care. For example,a restraint used for nonviolent be-havior may be appropriate for a patient with an unsteady gait, in-creasing confusion, agitation, rest-lessness, and a known history ofdementia, who now has a urinarytract infection and keeps pullingout his I.V. line.

Restraints for violent, self-destruc-tive behavior. These restraints aredevices or interventions for patients

who are violent or aggressive,threatening to hit or striking staff, orbanging their head on the wall, whoneed to be stopped from causingfurther injury to themselves or oth-ers. The goal of using such restraintsis to keep the patient and staff safein an emergency situation. For ex-ample, a patient responding to hal-lucinations that commands him orher to hurt staff and lunge aggres-sively may need a physical restraintto protect everyone involved.

Chemical restraintChemical restraint involves use of a drug to restrict a patient’s move-ment or behavior, where the drugor dosage used isn’t an approvedstandard of treatment for the pa-tient’s condition. For example, aprovider may order haloperidol in a high dosage for a postsurgical pa-tient who won’t go to sleep. (If thedrug is a standard treatment for thepatient’s condition, such as an an-tipsychotic for a patient with psy-chosis or a benzodiazepine for apatient with alcohol-withdrawaldelirium, and the ordered dosage isappropriate, it’s not considered achemical restraint.) Many healthcarefacilities prohibit use of medicationsfor chemical restraint.

SeclusionWith seclusion, a patient is held in aroom involuntarily and preventedfrom leaving. Many emergency de-partments and psychiatric units havea seclusion room. Typically, med-ical-surgical units don’t have such aroom, so this restraint option isn’tavailable. Seclusion is used only forpatients who are behaving violently.Use of a physical restraint togetherwith seclusion for a patient who’s

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straints When and how to use restraints

Learn about possible indications for restraint, types of restraints,and how to monitor patients in restraint.

By Gale Springer, RN, MSN, PMHCNS-BC

www.AmericanNurseToday.com January 2015 American Nurse Today 27

behaving in a violent or self-de-structive manner requires continu-ous nursing monitoring.

Determining when to use arestraintThe patient’s current behavior de-termines if and when a restraint isneeded. A history of violence or aprevious fall alone isn’t enough tosupport using a restraint. The deci-sion must be based on a currentthorough medical and psychosocialnursing assessment. Sometimes, ad-dressing the issue that’s underlyinga patient’s disruptive behavior mayeliminate the need for a restraint.

Also, caregivers must weigh therisks of using a restraint, whichcould cause physical or psychologi-cal trauma, against the risk of notusing it, which could potentially re-sult in the patient harming him- orherself or others. Input from theentire care team can help theprovider decide whether to use arestraint.

Alternatives to restraintsUse restraints only as a last resort,after attempting or exploring alter-natives. Alternatives include havingstaff or a family member sit withthe patient, using distraction or de-escalation strategies, offering reassur-ance, using bed or chair alarms, andadministering certain medications.

If appropriate alternatives havebeen attempted or considered buthave proven insufficient or ineffec-tive or are deemed potentially un-successful, restraint may be appro-priate. A provider order must beobtained for patient restraint. Besure to update and revise the careplan for a restrained patient to helpfind ways to reduce the restraintperiod and prevent further restraintepisodes.

Reducing restraint risksRestraints can cause injury andeven death. In 1998, TJC issued asentinel event alert on preventingrestraint deaths, which identified

the following risks: • Placing a restrained patient in a

supine position could increaseaspiration risk.

• Placing a restrained patient in aprone position could increasesuffocation risk.

• Using an above-the-neck vestthat’s not secured properly mayincrease strangulation risk if thepatient slips through the siderails.

• A restraint may cause furtherpsychological trauma or resurfac-ing of traumatic memories. To help reduce these risks, make

sure a physical restraint is appliedsafely and appropriately. With alltypes of restraints, monitor and as-sess the patient frequently. To re-lieve the patient’s fear of the re-straint, provide gentle reassurance,support, and frequent contact. Mon-itor vital signs (pulse, respiration,blood pressure, and oxygen satura-tion) to help determine how thepatient is responding to the re-straint.

Changing the culture The American Psychiatric NursesAssociation’s position statement onthe use of restraint suggests a unit’sphilosophy on restraint use can in-fluence how many patients areplaced in restraints. Interacting withpatients in a positive, calm, respect-ful, and collaborative manner andintervening early when conflict aris-es can diminish the need for re-

straint. Facility leaders should focuson reducing restraint use by sup-porting ongoing monitoring andquality-improvement projects.

To help ensure a restraint is ap-plied safely, nurses should receivehands-on training on safe, appropri-ate application of each type of re-straint before they’re required toapply it. Such training also shouldoccur during orientation and shouldbe reinforced periodically.

The goal is to use the least re-strictive type of restraint possible,and only as a last resort when therisk of injury to the patient or oth-ers is unacceptably high. Considerusing restraint only after unsuccess-ful use of alternatives, and only aslong as the unsafe situation occurs.Remember—restraint use is an ex-ceptional event and shouldn’t be apart of a routine protocol. •

Selected referencesAmerican Psychiatric Nurses Association. APNA Position Statement on the Use ofSeclusion and Restraint. Original 2000; re-vised 2007; revised 2014. www.apna.org/i4a/pages/index.cfm?pageid=3728. Accessed November 4, 2014.

American Psychiatric Nurses Association.Seclusion & Restraint Standards of Practice.May 2000; Revised May 2007; revised April2014. www.apna.org/i4a/pages/index.cfm?pageid=3730. Accessed November 4, 2014.

Federal Register. Part II; Department ofHealth and Human Services, Centers forMedicare & Medicaid Services; Medicare andMedicaid Programs. 42 CFR Part 482; Medi -care and Medicaid Programs; Hospital Condi-tions of Participation: Patients’ Rights; FinalRule. December 8, 2006. www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/downloads/finalpatientrightsrule.pdf. Accessed November 26, 2014.

Joint Commission, The. Hospital Accredita-tion Standards. Provision of Care, Treatmentand Services. Standards PC.03.05.01 throughPC.03.05.19. 2010.

Joint Commission, The. Sentinel Event Alert.Issue 8, November 18, 1998. Preventing Re-straint Deaths. www.jointcommission.org/assets/1/18/SEA_8.pdf. Accessed November4, 2014.

Gale Springer is a mental health clinical nursespecialist at the Providence Regional Medical inEverett, Washington.

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What isn’t a restraint?The following items aren’t consid-ered restraints:• devices used to immobilize a pa-tient temporarily during a diag-nostic procedure

• orthopedic supportive devices• helmets or age-appropriate pro-tective equipment, such asstrollers and cribs.

Keeping all side rails up on a bedfor seizure precautions and placingthe patient on a narrow stretcher areconsidered safety interventions, notrestraints.


Nurses at the bedside are ex-perts in driving the safest,most effective patient care. In

some cases, nursing assessmentand clinical judgment suggest theneed to apply restraints. A patientwho is violent or self-destructive orwhose behavior jeopardizes the im-mediate physical safety of him- orherself or another person maymeet the behavioral health require-ments for restraints. Examples ofsuch behaviors include:• hitting, kicking, or pushing• pulling on an I.V. line, tube, or

other medical equipment or de-vice needed to treat the patient’scondition

• attempting to get out of a bed,chair, or hospital room beforedischarge, in patients who areconfused or otherwise unable tofollow safety directions.Before using restraints, always

explore alternatives for keeping thepatient and others safe. When con-sidering such options, discuss withthe patient any conditions that mayneed to be addressed, such aspain, anxiety, fear, or depression. Ifdistraction and other alternativesprove ineffective at calming the pa-tient and he or she continues topose a risk, consult with otherhealthcare team members. You maywant to use an algorithm to helpdetermine if your patient requiresrestraints. (To access the author’salgorithm, visit www.AmericanNurseToday.com/Archives.aspx.)

Placing a patient in restraints re-quires a consult from the behav-ioral health team to consider be-havioral restraint options—forinstance, certain medications, dis-traction, seclusion, blanket wraps,

or manual locked restraints. If suchoptions don’t apply to your patient,proceed with restraints applicablefor nonviolent, nonself-destructivepatients, such as mitts, soft wristrestraints, or a chest vest. (See De-cision tree for nonviolent, nonself-destructive restraint.)

Restraint optionsWhich type of restraint to use de-pends on the patient’s behaviorand condition.

Hand mitts and freedom sleevesIf the patient is confused and im-pulsive and doesn’t follow direc-tions but can be redirected, consid-er hand mitts to decrease grabbingability. Or consider “freedomsleeves” (also called soft splints).These are a good deterrent for pa-tients trying to remove a medicaldevice from the face or head (suchas a nasogastric tube or drain).With freedom sleeves, patientshave difficulty bending their arms.Be aware, though, that the sleevesdon’t necessarily prevent themfrom removing I.V. lines.

Hand mitts and freedom sleeveslet the patient move the arms upand down but limit the ability tobend and grab tubes or drains.They can be removed by unstrap-ping the hook-and-loop closuresand sliding them off the arms. Besure to monitor patients closely be-cause they may try to remove theserestraints themselves.

Enclosure bedAn enclosure bed helps preventpatient injury by stopping the pa-tient from getting out of bed unas-sisted. It may be a good option for

patients who meet the criteria forthis bed. (For more information,read “Enclosure bed: A protectiveand calming restraint” in this issue.)

Chest vests and lap beltsChest vests and lap belts (alsocalled waist belts) may be warrant-ed for confused or impulsive pa-tients who are continually trying toget out of bed or a chair after re-peated redirection, when it’s unsafefor them to get up unaided. Applythe vest or belt according to themanufacturer’s instructions. Fastenit securely to an immovable part ofthe bed or chair. Make sure youcan easily slide your fingers under-neath the vest or belt so it’s nottoo tight. It shouldn’t press uncom-fortably against the skin, whichcould cause redness or impede ex-pansion of the patient’s midsectionduring respiration. Instruct the pa-tient to call for assistance when heor she wants to get up.

Limb restraintsSoft bilateral limb holders on bothwrists may be appropriate for pa-tients who are becoming increas-ingly agitated, can’t be redirectedwith distraction, and keep trying toremove needed medical devices.When device removal would poseserious harm to the patient andcause a significant setback to re-covery, or if the patient is a physi-cal threat to him- or herself or oth-ers, limb restraints help protect thepatient and staff and remind thepatient not to pull on the device.Typically, these restraints are usedfor patients in intensive care unitswho have endotracheal tubes, in-tracranial pressure monitoring de-

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straints Choosing the right restraint

Keeping patients and others safe is crucial, but restraints should be used only as a last resort.

By Christy Rose, MSN, RN, CCRN, CNRN


vices, chest tubes, external fixators,skeletal traction, or other deviceswhose removal would imperil thepatient’s health. In many cases,these patients are receiving seda-tives or opioids to relieve pain andanxiety, impairing their safetyawareness.

In more extreme cases, patientswho are severely agitated or intoxi-cated, are undergoing alcohol ordrug withdrawal, or can’t followsafety directions may require armand leg restraints, chemical re-

straint, or both. These methodsshould be used only for short peri-ods. Monitoring requirements maycall for one-to-one observation. Softlimb restraints are preferred, butlocked cuff restraints can be used if soft restraints prove ineffective.Chemical restraints require a pro -vider assessment and a one-time or-der with close patient monitoring.

Four-point restraints, which re-strain both arms and both legs,usually are reserved for violent pa-tients who pose a danger to them-

selves or others. Care-givers may use a com-bination of chemical se-dation and four-pointrestraints to calm thepatient as long as he orshe poses a danger.

Monitor the patientin four-point restraintsevery 15 minutes. Knowthat these restraintsmust be reduced andremoved as soon assafely possible. To re-duce a four-point re-straint, remove it slow-ly—usually one point ata time—as the patientbecomes calmer. Duringremoval, reorient thepatient and contractwith him or her for safebehavior.

A last resortKeeping patients andothers safe is extremelyimportant, but restraintsshould be used only as a last resort. Whenthey’re needed, choosethe least restrictive re-straint possible. Re-assess a restrained pa-tient continually andremove restraints assoon as possible. During the restraintepisode, educate pa-tients and their familiesabout the restraints and

keep them engaged in the care thepatient’s receiving. Be sure to docu-ment your assessment findings andprogress toward restraint removal tohelp “tell the story” of the restraintincident. •

Visit www.americannursetoday.com/?p=18948 for information on distraction tech-niques and on applying restraints and a list of selected references.

Christy Rose is a staff nurse in the surgical intensivecare unit at Denver Health Medical Center in Denver,Colorado.

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Decision tree for nonviolent, nonself-destructive restraint

© Christy Rose, MSN, RN, CCRN, CNRN. 2014.


An enclosure bed can be usedas part of a patient’s plan ofcare to prevent falls and pro-

vide a safer environment. This spe-cialty bed has a mesh tent connect-ed to a frame placed over astandard medical-surgical bed. Al-though it’s considered a restraintbecause it limits the patient’s abilityto get out of bed, an enclosure bedis less restrictive than other typesof restraints. It can be used as analternative when a vest restraintwould cause more agitation andwrist restraints aren’t appropriate.

My 750-bed academic medicalcenter became interested in the en-closure bed in 2007 as a way todecrease patient falls and patient-sitter costs. We’ve seen the enclo-sure bed have a calming effect onpatients and give them more free-dom than wrist and ankle re-straints. Our hospital rents the bed;for a 24-hour period, the dailyrental expense is much lower thanthe cost of a patient sitter. (See Alook at the enclosure bed.)

Indications Use of the enclosure bed hinges onthe patient’s behavior, so a patient-specific comprehensive assessmentmust be done. The bed may be in-dicated for patients who are at highrisk for falls; are confused, impul-sive, restless, or agitated; are unableto ask for assistance or respond toredirection; or who climb out ofbed when it’s unsafe to do so.

Other patients who might bene-fit from an enclosure bed includethose with Alzheimer’s disease orother types of dementia, traumaticbrain injury, seizure disorder, Hunt-ington’s disease, or developmental

delays. The bed also may be indi-cated for patients recovering fromstroke, as well as for patients withdelirium associated with alcoholwithdrawal who have completedtreatment for acute withdrawal.

Inclusion criteriaTo be considered for the enclo-sure bed, the patient must be athigh risk for falling and mustdemonstrate one or more of thefollowing:• impulsiveness• agitation• inability or unwillingness to ask

for assistance or respond to redi-rection

• unsteady gait• wandering behavior.

A history of falling alone isn’tenough to warrant use of the en-closure bed or other restraints.

Exclusion criteria Patients shouldn’t be placed in an

enclosure bed if they are violent,combative, self-destructive, suicidal,or claustrophobic. Although thebed has small holes for one or twoI.V. lines and an indwelling urinarycatheter, patients with multiplelines generally are excluded. If thepatient becomes increasingly agitat-ed, terrified, or distraught after be-ing placed in the bed, cliniciansmust reassess the situation and trya different intervention.

Evaluation periodBefore our hospital decided to addthe enclosure bed to our approvedspecialty rental inventory, staffnurses and other providers con-ducted an evaluation to identify pa-tient risk behaviors that could bemanaged in this bed. The hospitalconducted a 6-month trial of theenclosure bed, during which staffused the bed and completed anevaluation tool. The tool askedspecific questions about staff com-

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straints Enclosure bed: A protective and

calming restraint Learn about an alternative to more restrictive restraints.

By Jennifer L. Harris, RN, MS, NE-BC

A look at theenclosure bedThe enclosure bedshown here (manufac-tured by Posey Co.) isfor adults and children.A casing over the mat-tress is attached to thesides, preventing thepatient from slippingunderneath. The proce-dures used to elevatethe head of the bedand change bed heightare the same as thosefor a standard med-surg bed.


fort level with the bed, ease of use,family response to the bed, andwhether the bed met the patient’sneeds.

Education and implementationBased on staff feedback and posi-tive patient outcomes during theevaluation, the enclosure bed wasadded to potential interventions toprevent falls and to provide a saferenvironment for patients. Our facil-ity has developed processes to re-quest or order the bed, monitor thepatient while in the bed, and dis-continue the bed.

The enclosure bed was intro-duced as a type of restraint toproviders who have the authorityto order restraints. Staff nurses re-ceived education on indications forthe bed, how to operate it, anddocumentation requirements. Nurs-ing staff at the unit level workedwith provider teams to implementthe enclosure bed.

Education consisted of reviewingthe procedural checklist, watchingan instructional video and complet-ing a self-learning module on re-straint use. During the demonstra-tion on how to zip the panels anduse the locks on the zippers, nurs-es had the chance to get into thebed to see what it’s like.

Required processes Before an enclosure bed is request-ed, nursing staff must review withthe provider team the behavior thatputs the patient at risk for falls andinjury, as well as for impulsive be-havior that harm the patient orstaff. One example is an impulsivepatient with early-onset dementiawho is hitting and kicking at staff.

As with all restraints, an enclo-sure bed requires a provider re-straint order that must be renewedevery 24 hours. Before a patient isplaced in the bed, staff try less re-strictive options, such as distrac-tion, bed and chair alarms, reduc-ing stimuli, and moving the patientto a room closer to the nursing sta-

tion. Once the decision to use anenclosure bed is made, cliniciansmust educate the family about thebed, its function, the reason for us-ing it, how the panels are zippedand unzipped, and how the bedcontributes to a cocoon-like envi-ronment. If family members aren’tavailable in the hospital, the chargenurse contacts a family member byphone to explain the change in thepatient’s care.

Using a restraint flowsheet, nurs-ing staff document the patient’s re-sponse to the enclosure bed andthe frequency with which they metthe patient’s care needs during beduse.

When the patient’s behavior im-proves, the enclosure bed is dis-continued. The specialty bed coor-dinator is notified and the vendorpicks up the bed.

Placing the patient in the bedBefore using the bed, inspect it forproper assembly. Then unzip thebed and adjust the head of thebed. Once the patient has beenplaced in the bed, sit in a chairnext to the bed for a few minuteswith the sides unzipped to helphim or her get acclimated. Adjustthe head of the bed so the patientcan sit in it comfortably. Then zipthe sides and see how the patientreacts to the enclosure. If the pa-tient will be left alone, place a callbutton within reach.

The patient’s activity scheduleshould include getting him or herout of the bed multiple times aday. Staff should assist the patientto ambulate at least three timesdaily. The patient should sit in abedside chair for all meals, if ableto tolerate ambulation and activity.According to the Centers forMedicare & Medicaid Services’ Interpretive Guideline §482.13(e)(6), “a temporary, directly super-vised release…for the purposes of caring for a patient’s needs (e.g. toileting, feeding, or range-of-motion exercises) is not considered

a discontinuation of the restraint.As long as the patient remains under direct staff supervision, therestraint is not considered to bediscontinued because the staffmember is present and is servingthe same purpose as the restraint.”

OutcomesIn our hospital, the enclosure bedwas incorporated quickly into thesafety plan for med-surg patients.The adult med-surg nursing staffhas used the bed with more than200 patients. On average, patientsstay in the bed about 6 days; nopatient falls or injuries have oc-curred. In some facilities, using thebed decreases overall sitter expens-es. Our experience has shown aslight reduction in sitter hourswhen the bed is used.

Based on our positive experi-ences and patient outcomes, wewill continue to use the enclosurebed as an option for fall preventionand patient safety.

Several patients have been dis-charged from our hospital with aplan of care that included an enclo-sure bed. In the home, the bed canbe used for patients with agitationsecondary to dementia or for pedi-atric patients with significant chron-ic neurologic or behavioral prob-lems. The experience the familiesgained with the enclosure bed inthe hospital helped provide a safedischarge plan for several patients.

Involving staff with an initial tri-al of the bed, identifying appropri-ate patient criteria, and educatingstaff, patients, and families aboutthe bed’s benefits have contributedto successful implementation ofthis specialty bed. •

Visit www.americannursetoday.com/?p=18950 for information on caring for a patientin an enclosure bed, using the enclosure bedwith pediatric patients, and a list of selectedreferences.

Jennifer L. Harris is a senior advanced practice nurseat the University of Rochester Medical Center-StrongMemorial Hospital in Rochester, New York.

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Restraining a patient is consid-ered a high-risk interventionby the Centers for Medicare &

Medicaid Services, The Joint Com-mission (TJC), and various stateregulatory agencies, so healthcarepro viders must carefully assess anddocument the patient’s condition.

Assessing the patient’s medical con-dition Review the patient’s medical recordfor preexisting conditions that cancause behavioral changes—for in-stance, delirium, intoxication, andadverse drug reactions. If the be-havior results from an underlyingmedical problem, accurate assess-ment allows timely medical inter-vention and may reduce the re-straint period required or eveneliminate the need for restraint.

Assessing the patient’s behaviorTo establish the patient’s behavioral

baseline, assess his or her mentalstatus, mood, and behavioral con-trol. This allows clinicians to laterdetermine how the patient is toler-ating restraint and helps ensure re-straint will be discontinued as soonas clinically indicated.

Medications can be an importantpart of a restraint inter-vention. Appropriate useof as-needed medicationscan shorten the restrainttime. Assess the patient’sresponse to medications.

Assessment during the re-straint periodA restrained patient issusceptible to injuriescaused by restrictedbreathing, circulatoryproblems, and mechani-cal injuries. Once re-straints have been ap-plied, take steps toensure a safe, injury-freeoutcome. Perform a quickhead-to-toe assessment tohelp identify areas ofconcern or conditions

that require further monitoring. Being restrained is a traumatic

experience for the patient, so con-tinually assess how he or she isdealing with the stress.

DocumentationAccurate documentation of the re-straint episode is vital to safe, ef-fective patient care and providesinformation that can improve thequality of care. Document the rea-son for restraint and that you ex-plained the reason to the patientand family.

You can use a flowsheet to doc-

ument assessments. The flowsheetshould include the following: • patient behavior that indicates

the continued need for restraints• patient’s mental status, including

orientation• number and type of restraints

used and where they’re placed• condition of extremities, includ-

ing circulation and sensation• extremity range of motion • patient’s vital signs • skin care provided• food, fluid, and toileting offered.

Also, include the education youprovide to the patient and family.Remember—the goal is to removethe restraints as soon as possible.

Post-restraint debriefingWhen the restraint episode ends, anurse or other qualified caregivershould debrief the patient. Review-ing the restraint episode with thepatient yields important informa-tion that can help lead to restraint-free treatment. Information gainedfrom debriefing helps the treatmentteam design therapeutic interven-tions that may help prevent theneed for restraints. Be sure to doc-ument the debriefing.

Toward restraint-free careAccurate assessment and documen-tation of restraint episodes providevaluable information to improvetreatment processes, ultimatelyhelping nurses create an environ-ment where restraint-free care ispossible. •

Visit www.americannursetoday.com/?p=18952 for a list of selected references.

Jim Woodard is the associate chief nursing officer atPorter Adventist Hospital in Denver, Colorado.


Assessing and documenting patientrestraint incidents

Accurate information can promote restraint-free care. By Jim Woodard, RN, MBA

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focus on... safe use of restraints

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