Are Posey gloves (Physical restraint devices) considered a restraint?

From the Guidelines

Yes, posey gloves are considered a type of restraint in healthcare settings, specifically a form of mechanical restraint, as they limit a patient's freedom of movement and ability to interact with their environment. These specialized mittens prevent patients from using their fingers and hands effectively, limiting their ability to grab, pull, or manipulate objects including medical devices or tubes. Posey gloves are typically used for patients who might unintentionally harm themselves by pulling out tubes, lines, or scratching at wounds. While they may seem less restrictive than other restraints like wrist restraints, they still limit a patient's freedom of movement and require the same legal and ethical considerations as other restraints, as outlined in the practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint 1.

Some key points to consider when using posey gloves include:

• Obtaining proper orders and documenting the medical necessity for their use
• Attempting less restrictive alternatives first, such as verbal de-escalation techniques or environmental modifications
• Conducting regular reassessments to determine the continued need for the restraint
• Ensuring that the use of posey gloves is minimized whenever possible and used only as a last resort when patient safety is at risk and other interventions have failed, as recommended by the National Association of State Mental Health Program Directors and supported by policies from medical professional organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry 1.

It is also important to note that the use of restraints, including posey gloves, is subject to regulations and guidelines from federal agencies and hospital accreditation organizations, such as the Centers for Medicare and Medicaid Services and The Joint Commission, which emphasize the importance of using restraints in a humane and least restrictive manner 1. Additionally, the Journal of the American Academy of Child and Adolescent Psychiatry provides guidance on the use of physical restraint in child and adolescent psychiatric institutions, including the use of gloves, gowns, and face masks by staff in certain situations 1.

Overall, the use of posey gloves as a restraint requires careful consideration and adherence to established protocols and guidelines to ensure patient safety and well-being, while also minimizing the risk of complications and negative outcomes, as supported by the evidence from 1.

From the Research

Definition of Restraints

• A restraint is any physical or chemical measure used to limit activity or to control an individual's behaviour 2
• Restraints may include locked rooms, locked chairs, mummy bags, jackets, vests, wristlets, anklets, belts, mitts, joint splints, or pharmacological agents 2

Posey Gloves as Restraints

• Posey vests, which are a type of physical restraint, were most commonly used in inpatient rehabilitation facilities 3
• The use of Posey gloves, a type of physical restraint device, can be considered a form of restraint, as they are used to limit a patient's activity or control their behaviour 3

Use of Restraints in Healthcare Settings

• Physical restraints are used liberally in some intensive care units (ICUs) to prevent patient harm from device removal or falls 4
• The use of restraints has become an important issue for health care professionals and is just beginning to be considered by critical care nurses 2
• Restraint use may be associated with post-traumatic stress disorder (PTSD) in ICU survivors and is associated with delirium and longer duration of mechanical ventilation 4

Reduction of Restraint Use

• Minimising the use of restraint requires a multimodal approach to target both organisational and individual factors 5
• Interventions, such as nursing education, may effectively reduce restraint use by approximately 50% 4
• An adapted version of the Six Core Strategies, known as 'REsTRAIN YOURSELF', was developed and its impact upon physical restraint usage in mental health Trusts in the United Kingdom evaluated, resulting in an average reduction of restraint by 22% 5