National Alliance on Mental Illness
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Use Of Restraints And Seclusion
"The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to one's self or others. These extreme measures can be justified only so long as, and to the extent that, the individual cannot commit to the safety of themselves and others."
Adopted by the NAMI board of directors, October 25, 1998
The statement is a foundation for further work by the Subcommittee on Accreditation Oversight, Committee on Public Policy and Communications
EXISTING ADVOCACY POSITIONS
POLICY EXPANSIONS - February 9, 1999
Restraint and seclusion have no therapeutic value. They should never be used to "educate patients about socially acceptable behavior;" for purposes of punishment, discipline, retaliation, coercion, and convenience; or to prevent the disruption of the therapeutic milieu.
"Restraints shall be used only with a physician's order and only for emergency safety use. In emergency situations, a RN may initiate the use of restraints for the protection of the patient and/or others. Immediately the physician on duty/on-call shall be contacted and a verbal order must be obtained. The physician involved shall see the patient within thirty (30) minutes of the initiation of the restraints and document his/her assessment of the patient in the medical record. Orders shall specify up to one hour. Specific behavioral criteria written by the physician, including the patient's proclamation of safety, shall specify when the restraints will be discontinued, to ensure minimum usage. When a physician's order has expired, the patient must be seen by a physician and his/her assessment of the patient fully documented as an emergency safety use before restraints can be reordered. Restraints may only be continued for periods of up to one hour at a time and each renewal must be made by a face-to-face examination by the physician. (*)
(*) Based on the Pennsylvania Office of Mental Health and Substance Abuse existing policies and procedures.
Every restraint must be treated as a sentinel event1 and a root cause analysis2 must be generated.
Following each use of restraints and seclusion, the patient should receive trauma counseling.
Treating professionals must adhere to the patient's advance directive, if there is one.
Further Information: Clarke Ross, 703-312-7894
1 Sentinel event is defined by JCAHO as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. The phrase "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Events are called "sentinel" because they signal the need for immediate investigation and response.
2 A root cause analysis is a process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event.