Physical Restraint Use in Critical Care: Legal Issues

Abstract

Landmark federal legislation and several other social and clinical forces have induced nursing homes to reduce their use of physical or mechanical restraints on their residents during the past decade. Attention is being paid to the overuse of restraining devices and methods in acute care hospitals, including critical care units, and the need to develop strategies for their reduction or elimination. One of the most serious barriers to accomplishing this objective is anxiety on the part of health professionals and administrators about potential legal liability for patient injury. This article discusses the potential legal implications of physical restraint reduction in hospitals, with special emphasis on the critical care context. It places risks in realistic perspective, ultimately arguing that developing suitable alternatives to restraint use in most cases best serves the legal--as well as the clinical, ethical, and financial--interests of all concerned parties.

Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: Use of restraining therapies—American College of Critical Care Medicine Task Force 2001–2002

“…The use of restraints recently has come under increased scrutiny from institutions, external regulatory bodies, and the public (3). Some observers perceive that there is pervasive and inappropriate use of physical and chemical restraints in the ICU (4 -6).…”

Use of Physical Restraints in Neurosurgery: Guide for a Good Practice

“…The picture is even more complex by the nurse's obligation to ensure patient freedom, dignity, and autonomy (Reigle, 1996). Since everyone has the right to be free from forced restraint of movement, torture or degrading treatment (HMSO, 1998), nurses have to justify use of physical restraint (Kapp, 1996). However, the literature contained very little evidence of restraints providing protection.…”

British Association of Critical Care Nurses Position statement on the use of restraint in adult critical care units

“…Happ (2000) felt that the nurse's presence at the bedside was a crucial element in the reduction of the use of restraints and that the environment and use of other diversional therapies should also be considered. In the USA, legislation from the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission on Healthcare Organizations (JCAHO), 1996) and malpractice claims have led to a review of practice regarding the overuse of physical restraints (Kapp, 1996). As cited in Vance, (2003), the JCAHO standard for physical restraint must be limited to be ‘clinically appropriate, adequately justified and used only after all other non‐restrictive and innovative alternatives have failed’ (p. 87).…”

“…The majority of evidence on physical restraint comes from the USA where restraint techniques have been used in many clinical settings. However, there is little substantial evidence to support restraint in reducing patient self‐harm and injury (Kapp, 1996; Mion, 1996; Martin, 2002; Maccioli et al ., 2003). Evidence from the USA suggests that physical restraints were not consistent in preventing self‐extubation, indeed such interventions may aggravate and increase the incidence of patient agitation.…”