Least Restraint Policy in Healthcare

The “least restraint” policy is a guiding principle for healthcare facilities, mandating that all preventive, non-restraint methods must be attempted and failed with a client before the decision to use restraints is made.
A thorough assessment and analysis of the client's behavior is conducted by a regulated health-care professional to identify appropriate alternative methods.
If a restraint is deemed necessary, the policy dictates that the least restrictive restraint available must be chosen and applied (Alberta Health Services, n.d.).
Purpose: Restraints are exclusively for the client's safety and are never to be used for the convenience of staff.

Consent: Client consent is an absolute requirement before any restraint can be used.
Physician Order: Restraints may only be used if ordered by a physician.
Care Plan Integration: The use of restraints must be explicitly outlined within the client's care plan.
Monitoring Guidelines: Specific guidelines dictate how frequently a client must be monitored and checked when a restraint is in use.
Inappropriate Use: Misuse or improper application of a restraint, or its use when not properly assessed or indicated, can be considered a form of abuse (Alberta Health Services, n.d.).

Before implementing restraints, several critical factors must be identified and addressed:

Identify Reason(s): A regulated health-care professional must clearly identify the specific reason(s) for considering a restraint.
Identify Contributing Factors: Determine factors that contributed to the initial reason for considering a restraint (e.g., unmet client needs). This involves exploring and implementing alternative interventions, such as redirection and toileting, prior to restraint application.
Least Restrictive Option: Always ensure that if a restraint is necessary, the least restrictive available option is utilized.
Medication Dose: If medications are part of the intervention, they must be administered at the lowest possible dose appropriate for the client's physical and mental condition.
Continuing Care Facilities: In all continuing care settings (including long-term care facilities), the use of restraints must be documented in the individual's care plan, and the client's collaborative care team must be actively involved in the decision-making process.
Re-assessment: The collaborative care team is responsible for regularly re-assessing the client's condition to determine the continued necessity or potential discontinuation of the restraint.
Documentation: Comprehensive documentation of all aspects related to the use of restraints is mandatory.

Comfort Rounds: Comfort rounds are required for the client at least every $2$ hours to assess their comfort, hydration, toileting needs, and circulation.
Restraint Checks: The physical restraints themselves must be checked at least every $15$ minutes to ensure proper placement, condition, and client safety.