Fact Sheet Restraint (revised)
from Equip for Equality’s Legal Advocacy Program
EFE FACT SHEET – Mental HealthRESTRAINT IN A MENTAL HEALTH FACILITY IN ILLINOIS
Statutory References: 405 ILCS 5/1-125, 5/2-108; and the Center for Medicare and Medicaid Services (CMS) Rules
What is Restraint
Restraint means direct restriction through mechanical means or personal physical force of the arms, legs, head, or body of a person with a disability, which can include having one’s hands and feet tied to the sides of a bed.
What is not Restraint
Momentary periods of being physically held by another person with limited force, to prevent a person with a disability from completing an act that would result in potential physical harm to himself or herself or another person, are not considered restraint. They must, however, be documented in the person with a disability's clinical record. Also, partial or total immobilization of a person for the purpose of performing a medical, surgical, or dental procedure, or to treat an existing physical disorder is not restraint.
Rules about Restraint
Restraint is to be used only as an emergency measure to prevent a person with a disability from causing physical harm to himself or herself or physical abuse to others.
Restraint is never to be used for punishment, discipline, or as a convenience for the staff, and must be employed in a humane and therapeutic manner.
Before restraint is used, less restrictive alternative interventions must have been tried first.
Unless there is an immediate danger that the person with a disability will physically harm himself or herself or others, restraint must be loosely applied to permit freedom of movement.
The person with a disability in restraints must be permitted to have regular meals and toilet privileges free from the restraint, except when freedom of action may result in physical harm to the person with a disability or others.
Restraint may only be applied by a person who has been trained in the application of the particular type of restraint to be used, which training must include methods for controlling aggressive behaviors without using restraint.
Restraint by Written Order
Restraint is to be used only upon the written order of a physician, clinical psychologist, clinical social worker, or registered nurse with supervisory responsibilities unless an emergency exists (see Emergency Use of Restraints below).
To order restraint a physician, clinical psychologist, clinical social worker, or registered nurse with supervisory responsibilities must personally observe and examine the person with a disability and, from this observation, be clinically satisfied that the use of restraint is justified to prevent the person with a disability from causing physical harm to himself or herself or others. PRN (as needed) or standing orders are prohibited as authorization for the use of restraints.
What an Order for Restraint must Include
An order for restraint must state the events leading up to the need for restraint and the purposes for which restraint is employed. The order must also state the length of time restraint is to be employed and the reason for that length of time.
Length of Time in Restraint
Restraint may not last longer than 2 hours unless within that time period a nurse with supervisory responsibilitites or a physician confirms, in writing, that the restraint does not impose an undue risk to the health of the person being restrained given his or her physical or medical condition.
At the end of the initial time period, if further restraint is required, a new order must be written which complies with the requirements for the initial order for restraint. No order for restraint shall be valid for more than 16 hours.
Restraint may be employed during all or part of one 24-hour period that begins with the initial application of the restraint. However, once restraint has been employed during one 24-hour period, it cannot be used again on the same person with a disability during the next 48 hours without written authorization from the facility director.
Qualified personnel must check on a person with a disability in restraints at least once every 15 minutes to ensure that restraints were safely and correctly applied, and maintain a record of these observations.
Emergency Use of Restraint
In an emergency that requires its immediate use, restraint may be ordered temporarily by a qualified person if a registered nurse with supervisory responsibilities, clinical psychologist, clinical social worker, or physician is not available.
In that event, an order by a registered nurse with supervisory responsibilities, clinical psychologist, clinical social worker, or physician must be obtained as soon as possible. The person being restrained must be examined by a physician or supervisory nurse within 2 hours of the initial emergency restraint. Whoever orders restraint in emergency situations must document its necessity and place that documentation in the person with a disability's record.
Inform the Facility Director
The person who orders restraint in any case must inform the facility director or his designee in writing of the use of restraint within 24 hours.
Review of Orders for Restraint by Facility Director
The facility director must review all restraint orders daily and question any person who routinely orders them.
Proper Training in the Use of Restraints
Every facility that uses restraints must provide training to its staff in the safe and humane application of each type of restraint used. The facility may not authorize the use of any type of restraint by an employee who has not received this training. Each facility using restraint must maintain records detailing which employees have been trained and are authorized to apply restraint, the date of the training, and the type of restraint that the employee was trained to use.
Restraint of Persons who Communicate Using Sign Language
Whenever restraint is imposed upon a person with a disability whose primary mode of communication is sign language, the person with a disability must be permitted to have his or her hands free from restraint for brief periods each hour, except when freedom may result in physical harm to the person with a disability or others.
Restraint and Seclusion at the Same Time
A person who is restrained may only be secluded at the same time if there is explicit written authorization for the seclusion (See Fact Sheet on Seclusion). Whenever a person with a disability is restrained, a member of the facility staff must remain with him or her at all times, unless the person with a disability has been secluded. A person with a disability who is restrained and secluded must be observed by a qualified person as often as is clinically appropriate, but no less than every 15 minutes.
Notification to Others
Whenever restraint is used, the person with a disability must be advised of his or her right to have any person of his or her choosing notified of the restraint, including the Guardianship and Advocacy Commission or Equip for Equality. A person with a disability who is under guardianship may request notification to others whether or not his or her guardian approves. Whenever the Guardianship and Advocacy Commission is notified that a person with a disability has been restrained, it is required to contact that person with a disability to determine the circumstances of the restraint and whether further action is warranted.
Report of Deaths
If the facility receives Medicare or Medicaid funding, the facility director must report to CMS (Center for Medicare and Medicaid Services) any death that occurs when a person is in restraints or where it is reasonable to assume that the death was the result of being restrained. The report of death must be made during the next business day following the death.
DO YOU HAVE A QUESTION?
Contact Equip for Equality (all services are free of charge):
800.537.2532 (voice) or 800.610.2779 (TTY)
This resource material is intended as a guide for people with disabilities. Nothing written here shall be understood to be legal advice. For specific legal advice, an attorney should be consulted.
Equip for Equality, an independent nonprofit organization, is the Illinois state Protection & Advocacy System whose mission is to advance the human and civil rights of children and adults with disabilities.
This publication was made possible by a grant from the Center for Mental Health Services. The contents of this publication are the sole responsibility of the authors and do not represent the official views of the Center for Mental Health Services.
©Equip for Equality, 2005Revised: Revised: 06/01/2006
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