What is the correct procedure for using restraints on a client?

Restraint use is heavily regulated due to patient safety, dignity, and legal concerns. CMS, Joint Commission, and state laws require strict protocols. Key principles: (1) LAST RESORT — only after less restrictive measures (reorientation, distraction, family presence, bed/chair alarms, environmental modifications, sitter) have failed; (2) ORDER REQUIRED — physician/APN order within specified timeframe (varies); cannot be PRN (as-needed) standing orders; must be specific (type, reason, duration); (3) LEAST RESTRICTIVE — use the minimum restraint needed (e.g., one-point first before four-point); (4) TIME-LIMITED — orders limited to specific timeframes: 4 hours for adults, 2 hours for ages 9-17, 1 hour for under 9; (5) MONITORING — check every 15-30 minutes; assess skin integrity, circulation, respiratory status, hydration, hygiene, ROM, behavioral status, need for continued restraint; (6) RELEASE — every 2 hours minimum for ROM, toileting, hydration, repositioning; (7) ATTACHMENT — to bed FRAME, not side rails (side rails can be raised/lowered, injuring the patient); quick-release knots; (8) DOCUMENTATION — type, time, reason, alternatives tried, checks, releases, removal criteria; (9) CONTINUOUS REASSESSMENT — discontinue ASAP when criteria for removal met. Chemical restraints (medications used to restrict movement, not for medical condition) are also regulated. Side rails as restraints: all four rails up = restraint; partial rails for mobility assistance = not restraint.