• The patient has the right to be free from restraints that are not medically necessary. Restraints may be used only to protect the patient, staff, or others, and must be discontinued at the earliest possible time. Restraints must not be used for the convenience of staff or to punish a patient.
• The patient's family/caregivers must be involved in the plan of care. They must be consulted when the decision is made to use restraints. The family/caregivers must be instructed regarding the facility's restraint policy and alternatives to restraints that are available.
• Physical restraints should be considered only after assessment of the patient, environment, and the situation; interventions to relieve discomforting behaviors have been used, precipitating factors have been identified and eliminated, if possible; and consultation with other health care professionals has occurred.
• Alternatives to restraints and less restrictive interventions must have been implemented and failed. All alternatives used must be documented.
• Contradictions to physical restraints should be assessed.
• The benefit gained from using a restraint must outweigh the known risks for that patient.
• The restraints must be prescribed by a physician or other licensed practitioner who is responsible for the care of the patient. The order can never be for use on an “as-needed” basis.
• Once in place, the patient must be monitored and reassessed frequently, based on facility policy and patient status. The patient's vital signs must be assessed, and the patient must be visually observed every hour or according to facility policy.
• A physician or other licensed practitioner who is permitted to order restraint or seclusion in that health care facility and is responsible for the care of the patient must reevaluate and assess the patient every 24 hours (in the hospital setting) (CMS, 2006).
• Personal needs must be met. Provide fluids, nutrition, and toileting assistance every 2 hours.
• Skin integrity must be assessed, and range-of-motion exercises provided every 2 hours.
• Documentation regarding why, how, where, and for how long the restraints were placed, and patient monitoring is vital.

Source: Modified from Centers for Medicare & Medicaid Services (CMS). (2020a). Department of Health and Human Services. CMS manual system. Pub. 100-07. Appendix A. Survey protocol, regulations and interpretive guidelines for hospitals. §482.13. Conditions of participation: Patients' rights. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf; Centers for Medicare & Medicaid Services (CMS). (2020b). Department of Health and Human Services. CMS manual system. Pub. 100-07. Appendix PP. Guidance to surveyors for long term care facilities. §482.10. Resident rights. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf; and Centers for Medicare & Medicaid Services (CMS). (2006). Department of Health and Human Services. Federal Register. Part IV. 42 CFR Part 482. Medicare and Medicaid programs; Hospital conditions of participation: Patients' rights; Final rule. https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/downloads/finalpatientrightsrule.pdf