What is the ethical and legal requirement regarding the use of physical restraints?

• A. They must be used only when necessary with a physician's order, monitored continuously, and evaluated for least restrictive means; documentation.
• B. They can be used without any order.
• C. They must never be used.
• D. They must be replaced by pharmacologic means first.

Answer: (C)

Restraints are a safety measure used only when there is a real risk and no less restrictive option will protect the patient or others. Ethically and legally, this requires a physician’s order and ongoing oversight. Once in use, the patient must be monitored continuously for safety and comfort, and there must be a regular reassessment to determine if the restraint is still needed or if a less restrictive approach can be used. Documentation is essential, capturing the reason for restraint, the type of restraint, monitoring findings, the patient’s response, and the plan to discontinue as soon as it is safe. Regular checks should include checks of circulation, skin integrity, neurovascular status, and overall well-being, with a clear plan to release the restraint and reassess frequently. The idea that restraints can be used without an order, or that they are never permissible, or that pharmacologic means must always come first, does not align with standard ethical and legal practice.