Seclusion & Restraint in Psychiatric Settings

Seclusion and restraint in behavioral health are last-resort interventions used only when a client presents an immediate danger to self or others and less restrictive measures have failed. A licensed independent practitioner (LIP) must issue an order within one hour of initiation — a nurse may apply restraints in an emergency but cannot use a PRN or standing order. For adults, behavioral restraint orders must be renewed every 4 hours; for adolescents (9–17), every 2 hours; for children under 9, every 1 hour. If the client still requires restraint when the time limit expires, a new order must be obtained after reassessment — it is not simply renewed. A face-to-face assessment by the LIP (or a trained RN if permitted by facility policy) must occur within 1 hour of application. The client must be under continuous observation (1:1 or constant visual monitoring), with periodic physical assessments — including circulation, sensation, and skin integrity — at least every 2 hours, along with offering food, fluids, toileting, and reassessing readiness for release. The least restrictive intervention principle governs every decision: if the client regains behavioral control, restraints are removed immediately — not held until the order expires. Documentation must include the specific behavior warranting intervention, alternatives attempted, the client's response, and ongoing reassessments.