Physically restraining patients while they are being treated in the hospital sounds like a bad idea or at least a big deal. And it is. Nobody likes to do it, yet in most cases, it’s unavoidable.

Often it is done for the patient’s own safety. Confused and disoriented patients tend to pull tubes and catheters and climb out of bed. I have seen patients bleed after they pull out their IV catheters and rip out Foleys with a balloon inflated (the later is also very painful)

In the current healthcare environment when nurses have to attend to more and more patients, it is becoming a choice of having to stay at the bedside all the time to watch the patient, which is clearly impossible, or restraining the patient.

The attending physician has to sign a restraint sheet on the daily basis to confirm that restraints are necessary.

There are several types of restraints that are being use in the hospitals. The most common one is a wrist restraint . The patient’s hands are tied up in bed. Most confused/agitated patients and patients requiring sedation on a ventilator have these. In later case it is done to prevent the patient from pulling the breathing tube.

Chest restraints look like a vest that is tied to the bed or chair. This type is for more cooperative patients who sometimes “forget” to call for assistance when trying to get up. Once again, this is done for the patient’s own safety to prevent falls.

Less commonly used types of restraints include 4-points leather restraints for extremely agitated patients. This is as bad as it sounds – arms and leg tied up to the bed with leather bands. After putting somebody in 4-points, the restraint flowsheet should be signed every few hours by the doctor (hospitals in US).

Mittens restraints look like mittens that prevent patients from scratching, pulling etc. Usually, those are used along with wrist restraints.

Some really obnoxious patients also require a face mask (usual medical face mask) to prevent them from spitting at the staff.

The truth about restraints, though, is that most physicians sign the orders automatically, without verifying the real need to restrain. It is not uncommon for the doctor to sign orders for several previous days worth of restraints without even seeing the patient.

This is not to say that restraints are being used inappropriately. Nurses do an excellent job of deciding who should be restrained and how they should be restrained. As I mentioned above, restraints are an inevitable tool we use to keep patients safe in the hospital.

Signing the order for restrainets has become one of those formalities that should be done in order for the hospital to get through JACHO certification. Having physicians sign restraint orders does not identify or eliminate the unnecessary restraints; it just adds one more thing to the pile of paperwork to do.

What often does work is for the patient or the family to inquire about restraints during the physician’s visit. In many cases the need for restraints is obvious. Nobody wants to see their loved face down on the floor or bleeding after pulling a urinary catheter. In these cases the need to continue restraints should be explained to the family.

In other cases, “wait and watch” might become a reasonable approach to see if the patient needs further restraining.

As the population gets older, patients with dementia will become more “prevalent” in our hospital wards. With more confused patients being admitted to the hospital, restraints will be used even more often. This is an unfortunate, but yet true trend when it comes to restraints utilization. Adding more paperwork and hassles for the physicians will not solve it.