How to Use Wrist Restraints Safely

Wrist restraints should only be used when a patient is deemed to be a danger to himself or others. They should only be used under the order of a physician and according to local and state laws. There are several steps to follow to use wrist restraints safely.

Things You'll Need

• Physician's order
• Wrist restraints
• Patient's medical record

Instructions

1. Obtain a physician's order to use wrist restraints. Restraints can only be applied with a legal order from a licensed physician once the patient has demonstrated that he is a risk to himself or others. Also, follow your facility's policy and local laws pertaining to the use of restraints.

2. Explain to the patient and to his family why restraints have been ordered by the physician. This is an important step even if the patient does not seem to be mentally coherent. Reassure the patient that he is safe and will be monitored closely. Inform him that the restraints will be removed as soon as the physician feels that they are no longer needed.

3. Apply wrist restraints to the patient according to the manufacturer's instructions and per your facility's protocol. Tie the restraints in a manner in which you can easily and quickly remove them in the event of a fire or other emergency. Ensure that you can slip two to three fingers underneath the restraints to prevent circulation obstruction and skin breakdown. Additionally, make sure the restraints are attached to a part of the bed that will move when the bed is being adjusted.

4. Assess the patient every 15 minutes while the restraints are still in use. Observe the nail beds on the patient's fingers and look to see if they return to their normal pink color after gently pinching them. If they do not, the restraints may be applied too tight. Ensure that circulation is normal in the patient's hands and fingers. Look for reddened areas around the restraints, which may be a sign of skin breakdown.

5. Remove the wrist restraints for at least 15 minutes every two hours. Assess the skin that was under the restraint to make sure the patient is not developing pressure ulcers, and check circulation again. Allow the patient to use the restroom or have a drink of water if possible.

6. Document all assessment findings in the patient's medical record. Every 15 minutes and every two hours, you should document your observations and all behavior exhibited by the patient. This is a very important rule that must be followed when using wrist restraints. In your documentation, include the type of wrist restraints used, their manufacturer, and when they were applied and removed.

Tips & Warnings

• If possible, remain with the patient for the duration of restraint use for monitoring. It may be helpful to set an alarm on a watch or cell phone to ensure that you remember to assess the patient every 15 minutes.

• Never apply wrist restraints above an IV site. This can cause the IV to infiltrate and damage tissue and veins. If the patient has an IV below the area where you will be applying the wrist restraints, discontinue the IV and start a new one before applying them. Get an order to remove wrist restraints from the physician as soon as possible. Never apply restraints without the order of a physician as this can be grounds for a lawsuit.

References

• Applying wrist restraints
• Techniques for Physical Restraint of Patients
• Patient Rights During Restraint Use