Table 12.

Instructions to the staff carrying physical restraint

Before physical restraint

Know the steps and plan clearly

Adheres to the plan discussed to execute the use of physical restraint safely. Ensure that mechanical and postural factors should not interfere in breathing or circulation: e.g., to avoid prone restraint or any other position where the patient’s head or trunk is bent towards their knees

During the physical restraint

Physical force used should be as per the necessity and in a reasonable manner

To avoid excessive physical force or verbal aggression

Ensure and monitor ABC all the time: Airway, Breathing, Circulation

Consciousness and body alignment have to be monitored by the clinician

Do not put direct pressure on the neck, chest/thorax, back, or pelvic area

Nurse/resident doctors/duty doctors must observe for physical or mental distress indications and ensure that clinical concerns are timely and appropriately escalated and appropriate intervention is provided

Specifically, monitor patients who have received intramuscular or intravenous medication within an hour before (or during) the use of physical restraint

On period reviews, if necessary, physical restraint positions can be changed as per the need and safety of the patient

Discontinue physical restraint as soon as it is no longer required

Risk assessment of continuing or discontinuing the physical restraint needs to be continuously assessed and balanced

Postrestraint debriefing

After the physical restraint ends and the patient is cooperative, a debriefing session with the patient and the patient’s caretakers must be conducted. This is done

To ensure open discussion about the events that led to the use of physical restraint

To discuss the patient’s experience of events and physical restraint

To allow the patient to clarify any doubts or seek more details

To provide an opportunity to identify the risk factors and plan strategies for the prevention of the need for physical restraint