Understanding Joint Commission Restraint Standards
An interactive guide to the principles and practices for patient restraint and seclusion. This application breaks down the core requirements to ensure patient safety and protect patient rights, emphasizing restraint as a last resort.
Core Principles
The Joint Commission's standards are built on a foundation of patient safety and rights. The primary goal is to reduce the use of restraints by prioritizing prevention and de-escalation. Explore the key principles below.
Last Resort
Restraints should only be used when less restrictive interventions have proven ineffective to prevent harm.
Discontinue ASAP
Restraints must be removed at the earliest possible time, once it is safe to do so.
Qualified Staff
Only trained and competent staff can initiate, monitor, and discontinue restraints.
Protect Rights & Dignity
Patient rights, dignity, and well-being must be protected throughout the process.
Acceptable Use of Restraints
Restraints are permissible only in specific situations where there is an imminent risk of harm. The standards differentiate between use for managing violent/self-destructive behavior and for medical/surgical purposes. Use the tabs below to explore the criteria for each.
For Violent or Self-Destructive Behavior
This type of restraint is used to manage behavior that poses an imminent threat to the patient or others. It requires intensive monitoring and evaluation.
- ✓Used only for behavior that jeopardizes the immediate physical safety of the patient, staff, or others.
- ✓Requires an in-person evaluation by a Licensed Independent Practitioner (LIP) within one hour of initiation.
- ✓Orders are time-limited: 4 hours for adults, 2 hours for adolescents (9-17), and 1 hour for children under 9.
- ✓Requires continuous in-person monitoring or simultaneous audio/video monitoring.
Documentation & Monitoring
Thorough and timely documentation is critical for compliance and patient safety. This includes the initial order, ongoing assessments, and eventual discontinuation. The chart below visualizes the minimum frequency of key actions.
Required Documentation Checklist
Monitoring Frequency (Behavioral Health)
Protecting Patient Rights
The standards place a strong emphasis on preserving the rights and dignity of the patient. Facilities must have clear policies to ensure these rights are upheld before, during, and after a restraint event. Click on each right to learn more.
Restraint or seclusion may not be used as a means of coercion, discipline, convenience, or retaliation by staff.
Restraints must be applied by trained staff in a way that minimizes the risk of physical and psychological harm and ensures the patient's physical safety.
Patients and/or their families must be informed about the hospital's policy on restraint use and the reasons for its application in their specific case, as appropriate.
Patients have the right to participate in their care planning. This includes involvement in developing criteria for how their restraint or seclusion can be discontinued.
Staff Training Requirements
Competent staff are the cornerstone of safe restraint practices. The Joint Commission requires comprehensive, ongoing training for all staff members who may be involved in a restraint event. The chart highlights the essential components of this training.
Key Training Areas
Verbal & Non-Verbal De-escalation
Techniques to calm agitated patients and resolve conflicts without physical intervention.
Alternatives to Restraint
Strategies like environmental changes, redirection, and offering choices to manage behavior proactively.
Proper Application & Removal
Hands-on training in the safe and correct use of specific restraint devices used by the facility.
Patient Monitoring
Recognizing and responding to signs of physical and psychological distress during restraint.
Organizational Policies
Understanding facility-specific procedures, patient rights, and reporting requirements.