By Stacey Kusterbeck
Some ED patients are so out of control, despite all attempts at de-escalation, that they require restraint. In such cases, there are significant risks for everyone involved. “It’s demeaning and unpleasant, for both patients and staff,” says John Tafuri, MD, FAAEM, former regional director of emergency medicine at the Cleveland Clinic. If the patient has demonstrated violence (or a propensity to violence based on their history), it is reasonable for an emergency nurse to ask for a restraint. “It’s a judgment call, but I would document the violence or history of violence in the medical record to justify the restraint,” Tafuri suggests.
However, each encounter must be judged separately. One prior episode of violence may not be applicable if the patient is currently cooperative. Providers should not rely solely on an earlier episode of violence to justify restraint, according to Tafuri.
When restraint is considered, patients should be given the benefit of the doubt and treated with respect. “We always want to treat everybody properly. There is no value in restraining a patient who has not displayed violence,” Tafuri says.
On the other hand, staff also have the right to be protected. “To be fair, you always want to give the patient the benefit of the doubt. But we also need to listen to staff if they say they don’t feel safe,” Tafuri notes.
Some nurses may refuse to care for a patient due to experience, documented history of violence, or threatening behavior. “I don’t think you have the right to refuse to treat a patient with a history of violence. But you do have a right to demand reasonable measures for your safety,” Tafuri offers.
The Joint Commission requires specific documentation on the use and monitoring of restraints on a patient.
“Strict compliance with these requirements is mandatory,” Tafuri says. “In addition, I would include a narrative of the circumstances and findings that would justify the use of restraints.”
Personal animus or emotion on the part of an ED provider should never be a rationale for the use of restraints. EDs are at risk for allegations of unlawful restraint or assault in circumstances where the use of restraints is not justified.
“If there is evidence that anger or animus was improperly the rationale for restraint, the provider may be subject to civil or even criminal action,” Tafuri says.
Personal animus or emotion on the part of an emergency provider should never be a rationale for the use of restraints. EDs are at risk for allegations of unlawful restraint or assault in circumstances where the use of restraints is not justified.
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