Chapter 24 - Restraint and seclusion techniques in the emergency department

Summary

Restraints are used in the healthcare setting primarily in two general situations: violent and/or self-destructive situations when the patient has demonstrated or poses an imminent danger to themselves or another, and disruption of therapy or non-violent, non-self-destructive situations. Chemical restraints are an effective and safe tool in caring for patients when used wisely. This chapter intends to provide an overview of the pharmacology, indications, side effects, and dosages of the three most commonly used medications for chemical sedation: lorazepam, haloperidol, and ketamine. Physical restraint application requires training and the demonstrated competency of involved staff. Alternatives to both chemical and physical restraints should always be explored before their initiation. Seclusion is another form of behavior control used in emergency departments and hospitals, and is simply defined as the confinement of a patient in a closed space for a specific amount of time.