What is the difference between medical and behavioral restraints?

Medical vs. Behavioral Restraints: Key Differences

Medical restraints are used to prevent disruption of medical treatment or protect patients from harming themselves unintentionally, while behavioral restraints are specifically used to manage violent or self-destructive behavior that poses an immediate safety risk to the patient or others. 1

Definitions and Purposes

Medical Restraints

• Used to prevent interference with medical treatment (e.g., preventing a confused patient from pulling out IV lines, tubes, or catheters) 2
• Primarily focused on ensuring completion of necessary medical interventions 3
• Often used for patients with altered mental status who lack decision-making capacity but are not displaying aggressive behavior 3, 4
• The goal is protection from accidental self-harm rather than management of intentional aggression 3

Behavioral Restraints

• Used when a patient presents an acute danger to harm themselves or others through intentional actions 1
• Applied in response to aggressive, violent, or severely agitated behavior 1
• Implemented when there is significant disruption of the treatment plan including considerable disruption of property 1
• Used only after less restrictive measures have failed or are not possible options 1, 5

Types of Restraints

Physical Restraints

• Involve one or more staff members in bodily contact with the patient without using mechanical apparatus 1
• For children, physical restraint (holding) is often preferred over mechanical restraints 1
• Requires continuous monitoring by trained staff 1

Mechanical Restraints

• Use of leather or cloth restraints, papoose boards, calming blankets, body carriers, and other implements 1
• More commonly used with adolescents to assist with regaining self-control 1
• Associated with higher risk of complications including skin breakdown, neurovascular damage, and potential for asphyxiation 1

Chemical Restraints

• Medication used to control behavior or restrict a patient's freedom of movement that is not standard treatment for the patient's medical or psychiatric condition 1
• Distinct from ongoing medication used to treat symptoms of underlying psychiatric illness 1
• Commonly used medications include benzodiazepines (e.g., lorazepam) and antipsychotics (e.g., haloperidol) 5
• May be preferable in cases of agitation due to suspected illicit stimulant use to prevent complications from rhabdomyolysis 1

Regulatory Requirements

• Both types of restraints require:
  • Orders from a licensed independent practitioner (physician, nurse practitioner, physician assistant) 1
  • In-person evaluation within 1 hour of restraint placement 1
  • Regular renewal of orders based on patient age (every 1 hour for children under 9, every 2 hours for ages 9-17, every 4 hours for adults) 1
  • Assessments every 15 minutes for vital signs, signs of injury, circulation, and readiness to discontinue restraint 1

Key Differences in Application

• Medical restraints may be maintained for longer periods if medically necessary 3
• Behavioral restraints are intended to be temporary and should be removed as soon as the patient no longer presents a danger 1
• Behavioral restraints require more frequent reassessment and renewal of orders 1
• For children and adolescents with trauma history, seclusion may be preferred over physical or mechanical restraints for behavioral management 1

Common Pitfalls to Avoid

• Using restraints for staff convenience rather than patient necessity 5
• Failing to try less restrictive alternatives before implementing restraints 1
• Inadequate monitoring of restrained patients, which can lead to complications 1
• Using prone positioning, which has been associated with deaths due to airway obstruction 1
• Restraining medically compromised or unstable patients without appropriate precautions 1
• Failing to document the rationale for restraint use and ongoing assessments 1

Remember that all restraint use should be considered a last resort after less restrictive interventions have failed, with the primary goal being to ensure safety while preserving dignity and preventing harm 1, 4.