Use of Patient Restraints

Reaffirmed by the ACEP Board of Directors October 2007
Revised and approved by the ACEP Board of Directors with the same title April 2001 June 2000 January 1996
Originally approved by the ACEP Board of Directors January 1991 

The American College of Emergency Physicians (ACEP) supports the careful and appropriate use of patient restraints or seclusion. ACEP recognizes that patient restraint involves issues of civil rights and liberties, including the right to refuse care, freedom from imprisonment, and freedom of association. However, there are circumstances when the use of restraints is in the best interest of the patient, staff, or the public.

Methods of patient restraint include physical restraints, chemical restraints, and seclusion. Patient restraint should be considered when a careful assessment establishes that the patient is a danger to self or others by virtue of a medical or psychiatric condition.

ACEP endorses the following principles regarding patient restraints:

• Restraints should be individualized and afford as much dignity to the patient as the situation allows.
  
   
• Any restraints should be humanely and professionally administered.
  
   
• Protocols to ensure patient safety should be developed to address observation and treatment during the period of restraint and periodic assessment as to the need and means of restraint.
  
   
• The use of restraints should be carefully documented. Such documentation should include the reasons for and means of restraint and the periodic assessment of the restrained patient.
  
   
• The method of restraint should be the least restrictive necessary for the protection of the patient and others.
  
   
• ACEP opposes any requirement by hospital representatives or medical staffs that emergency physicians provide inpatient restraint or seclusion orders. Patient restraint or seclusion requires comprehensive patient assessment, ¹ and the emergency physician’s principal legal and ethical responsibility is to patients who present to be seen and treated in the emergency department. ²
  
   
• The use of restraints should conform to applicable laws, rules, regulations, and accreditation standards.

References 

1. 42 CFW 482.13(f).
2. American College of Emergency Physicians. Emergency physicians’ patient care responsibilities outside of the emergency department [policy statement]; Approved September 1999. Ann Emerg Med 2000;35:209.