Laboratory Work Before Initiating Restraint
Laboratory work is generally not necessary before initiating restraint, but a comprehensive medical history should be obtained to ensure patient safety. 1
Medical Evaluation Before Restraint
Medical History Requirements
- A thorough medical history should be obtained before initiating restraint to:
- Ensure no medical problems could account for the patient's behavior
- Confirm the patient is healthy enough to undergo restraint with minimal risk 1
- Identify any conditions that might increase risk during restraint
When Laboratory Testing Is Appropriate
- Targeted medical testing may be appropriate in specific situations:
- When initiating medications with known risks that may be used alongside restraint
- To establish a medical baseline in patients with known medical conditions
- When there is clinical suspicion of an underlying medical cause for the behavior 1
What Not to Delay For
- Restraint should not be delayed for routine laboratory work when:
- There is an immediate safety risk to the patient or others
- The patient is actively aggressive or violent
- Delay would increase risk of harm 1
Evidence Supporting Limited Pre-Restraint Testing
The American Academy of Child and Adolescent Psychiatry practice parameters indicate that while a medical history is necessary before initiating pharmacotherapy or restraint, routine laboratory testing completed by a specialist is not necessary before most interventions 1. This approach balances safety with the need for timely intervention in crisis situations.
Safety Considerations
Contraindications to Restraint
- Physical or mechanical restraints that could cause airway obstruction
- Restraints that prevent head rotation
- Restraint positions that could lead to aspiration 1
Monitoring Requirements
- When physical restraint exceeds 15 minutes, reassessment by nursing staff and attending psychiatrist is clinically indicated 1
- Vital signs should be monitored during restraint episodes
Communication and Documentation
Good communication among medical, mental health, and other professionals involved in the patient's care is essential for safe and effective use of restraint 1. This includes:
- Communicating with other professionals during the evaluation process
- Setting the stage for monitoring during the restraint episode
- Documenting the rationale for restraint and ongoing assessments
Conclusion
The evidence clearly supports obtaining a medical history before initiating restraint, but does not mandate laboratory testing in most cases. The focus should be on ensuring patient safety through appropriate assessment and monitoring rather than delaying necessary intervention for laboratory results that are unlikely to change management.