title: Beyond emergencies: the use of physical restraints in medical and psychiatric settings.
abstract: Physical restraints, such as locked-door seclusion and two- or four-point leather restraints, are frequently used in both the medical and psychiatric settings. Efforts are currently under way to reduce the use of physical restraints in psychiatric settings; various institutional, state, and federal policies are place. However, using these same restraints in the context of providing medical care for psychiatric patients is more complicated, as it is uncertain which principles and regulations apply in a particular setting. For example, is the restraint governed by the policies that regulate the psychiatric application of restraints, by those that regulate the medical application of restraints, or by both? This article reviews the principles and regulations governing the use of restraints on psychiatric patients, with specific attention to the use of restraints in providing medical treatment to that patient population. Also addressed are general principles of risk management to help avoid negative outcomes and to reduce the risk of litigation for unauthorized or unlawful restraint. A case example is used to illustrate these concepts.
authors.affiliation: Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA. aglezer@partners.org
authors.forename: Anna
authors.initials: A
authors.lastname: Glezer
authors.forename: Rebecca Weintraub
authors.initials: RW
authors.lastname: Brendel
mesh_terms: D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D008318:Malpractice / Q000331:legislation & jurisprudence; D016743:Mental Competency / Q000331:legislation & jurisprudence; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D010356:Patient Isolation / Q000331:legislation & jurisprudence*; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy; D012149:Restraint, Physical / Q000331:legislation & jurisprudence*; D012308:Risk Management / Q000331:legislation & jurisprudence; D016312:Treatment Refusal / Q000331:legislation & jurisprudence; D014481:United States