Restraint and Seclusion - Enclosure Beds, Side Rails and Mitts
Is an enclosure bed, side rails, or hand mitts a restraint?
Any examples are for illustrative purposes only.
Enclosure Bed/Side Rails
Restricting a patient's freedom from exiting the bed
The use of restraints for the prevention of falls should not be considered a routine part of a fall prevention program. Use of restraints as a fall prevention approach has major, serious drawbacks and can contribute to serious injuries.
Protecting a patient from falling out of bed
Enclosure Bed/Side Rails
The determination as to whether raised side rails would be considered a restraint is based on multiple factors, including method of use and whether it immobilizes or reduces the ability of a patient (or a body part) to move freely.
Restricting a patient's freedom from exiting the bed
- If raising the side rails prevents a patient from voluntarily getting out of bed or attempting to exit the bed, this would be restricting the patient's freedom of movement and the side rails would be considered a restraint.
- Use of an enclosure bed or net bed that prevents a patient from freely exiting the bed is considered a restraint. (An exception is the age-appropriate use of an enclosed crib for infants and/or toddlers.)
- The number of raised side rails used may also be a factor. When all four side rails are used to prevent a patient from exiting the bed, this would be a restraint, however, raising fewer than four side rails when the bed has segmented side rails would not necessarily immobilize or reduce the ability of a patient to move freely. For example, if the side rails are segmented and all but one segment are raised to allow the patient to freely exit the bed, the side rails are not acting as a restraint. On the contrary, if the bed has non-segmented rails that when both raised does not allow the patient to freely exit the bed, the side rails would be acting as a restraint.
- If a patient is not physically able to get out of bed, regardless of whether the side rails are raised or not, raising all four side rails for this patient would not be considered restraint because the side rails have no impact on the patient's freedom of movement.
The use of side rails is inherently risky, particularly if the patient is elderly or disoriented. Patients may be at risk for entrapment, entanglement, or falling from a greater height posed by the raised side rail, with a possibility for sustaining greater injury or death. The risk presented by side rail use should be weighed against the risk presented by the patient's behavior as identified through individualized assessment.
The use of restraints for the prevention of falls should not be considered a routine part of a fall prevention program. Use of restraints as a fall prevention approach has major, serious drawbacks and can contribute to serious injuries.
Protecting a patient from falling out of bed
- If raising the side rails prevents the patient from inadvertently falling out of bed, then it is not considered a restraint. Examples include raising the side rails when a patient is on a stretcher, recovering from anesthesia, sedated, experiencing involuntary movement, or on certain types of therapeutic beds to prevent the patient from inadvertently falling out of the bed.
Hand Mitts
Hand mitts would be considered a restraint if:
- The mitts are pinned or otherwise attached to the bed/bedding or are used in conjunction with wrist restraints and/or
- The mitts are applied so tightly that the patient's hands or fingers are immobilized, and/or
- The mitts are so bulky that the patient's ability to use their hands is significantly reduced, and/or
- The mitts cannot be easily removed intentionally by the patient in the same manner they were applied by staff considering the patient's physical condition and ability to accomplish the objective.
If the mitts meet any of the above criteria, they would be considered a restraint.
Manual:
Critical Access Hospital
Chapter:
Provision of Care Treatment and Services PC
Last reviewed by Standards Interpretation: July 20, 2022
Represents the most recent date that the FAQ was reviewed (e.g. annual review).
First published date: April 11, 2016
This Standards FAQ was first published on this date.
This page was last updated on July 20, 2022
with update notes of: Review only, FAQ is current
Types of changes and an explanation of change type:
Editorial changes only: Format changes only. No changes to content. |
Review only, FAQ is current: Periodic review completed, no changes to content. |
Reflects new or updated requirements: Changes represent new or revised requirements.
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