Communications to the Editor |

Prudent Restraint Use FREE TO VIEW

Luke A. Pluto, MD, FCCP
Author and Funding Information

Southway Internists, Lewiston, ID

Correspondence to: Luke A. Pluto, MD, FCCP, Southway Internists, 222 Southway, Lewiston, ID 83501

Chest. 1999;116(3):843. doi:10.1378/chest.116.3.843
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To the Editor:

Recently, the hospitals where I practice have become very concerned about the use of restraints. Apparently, the Joint Commission on Accreditation of Healthcare Organizations is looking very carefully at the use of restraints and is requesting specific orders and progress notes on a regular basis in order to address the issue of the use of restraints. Obviously, this investigation is a good thing, but it appears to me that the issue is not in keeping with my experience, and I am concerned that the Joint Commission may be taking things a little too far.

In my experience practicing in several states in the Midwest and the Pacific Northwest, I have found more instances in which there was the potential for a problem when the patient was not restrained. These potential problems include falls, self-extubation, and self-removal of central lines.

I am confused when I try to reconcile the sentinel event policy with the recent concern about restraints. It seems to me that restraints are sometimes necessary, but the impression I receive from the Joint Commission is that restraints are inherently evil. Unless my experience differs greatly from that of other practicing pulmonologists, I have seen more problems when restraints were not used than from their improper use. If I am ignorant of an important body of literature in this regard, please let me know.




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