Chart — Geriatrics
Restraint Use and Alternatives Chart
Restraints are a last resort with strict requirements — and most agitation has a findable cause. Alternatives come first; when a restraint is unavoidable, the rules below protect the patient and your license.
Data Source: CMS Conditions of Participation / Joint Commission Standards
Educational use only. Restraint use is governed by law, regulation, and facility policy; always follow your institution’s current restraint protocol and provider orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Alternatives to Try First
| Strategy | Examples | Best For |
|---|---|---|
| Find the cause | Pain control, toileting schedule, hunger, hypoxia check, medication review | Nearly all new agitation — agitation is communication |
| Environment | Bed in low position, clutter-free room, night light, familiar objects, quiet at night | Fall risk, sundowning, disorientation |
| Engagement | Family at bedside, sitter or video monitoring, activity apron, music, frequent rounding | Wandering, line-pulling, restlessness |
| Camouflage and comfort | Cover or wrap IV lines, abdominal binder over tubes, comfortable positioning | Device interference without intent to harm |
| Reorientation routines | Glasses and hearing aids on, clocks and calendars visible, consistent caregivers | Delirium and dementia-related confusion |
If a Restraint Is Required
| Requirement | Standard | Notes |
|---|---|---|
| Order | Provider order required — never PRN | In an emergency, obtain the order immediately after application per policy |
| Least restrictive | Use the least restrictive device that works | Mitt before wrist; one limb before four |
| Monitoring | Per policy — commonly every 15 min (violent) to every 2 hr (non-violent) | Circulation, skin, positioning, and basic needs each check |
| Release | Release at regular intervals — commonly every 2 hours | Range of motion, toileting, fluids, skin care |
| Renewal | Time-limited orders; renewed per policy with provider re-evaluation | Behavioral restraints have the shortest renewal windows |
| Documentation | Behavior necessitating restraint, alternatives tried, patient response, ongoing assessment | “Alternatives attempted” must be specific |
| Application | Quick-release knot to bed frame, never side rail; two-finger space under device | Raising all four side rails is itself a restraint |
NCLEX Pearls
- ✦A restraint requires a provider order, time limit, and documented alternatives — “family requested it” is never sufficient.
- ✦Tie to the movable bed frame with a quick-release knot, never the side rail.
- ✦Check circulation and skin at every monitoring interval; release and exercise per schedule.
- ✦Restraints increase delirium, deconditioning, and injury — they do not reliably prevent falls.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with CMS Conditions of Participation / Joint Commission Standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →