Improper Use of Restraint

Effective 7/24/2015 (SSB 5600): The law defines [RCW 74.34.020(2)(e)] improper use of restraint as the inappropriate use of chemical, physical, or mechanical restraints for convenience or discipline or in a manner that:  (i) Is inconsistent with federal or state licensing or certification requirements for facilities, hospitals, or programs authorized under chapter 71A.12 RCW; (ii) is not medically authorized; or (iii)  otherwise constitutes abuse under this section.

  • RCW 74.34.020(3)] Chemical restraint means the administration of any drug to manage a vulnerable adult’s behavior in a way that reduces the safety risk to the vulnerable adult or others, has the temporary effect of restricting the vulnerable adult’s freedom of movement, and is not standard treatment for the vulnerable adult’s medical or psychiatric condition.

An Example of a Chemical Restraint

Matthew lives in a nursing facility because of his dementia and lack of ability to perform his ADLs.  Matthew has Sundowners, is up late at night pacing the hall, and loses his way, going into other people’s rooms.  Matthew often appears distressed, yelling, “help, help!”  Tired of redirecting Matthew, the nurse gave him 50mg of Benadryl so Matthew would sleep.

  • RCW 74.34.020(14)] Mechanical restraint means any device attached or adjacent to the vulnerable adult’s body that he or she cannot easily remove that restricts freedom of movement or normal access to his or her body.  “Mechanical restraint” does not include the use of devices, materials, or equipment that are:
    (a) medically authorized, as required, and
    (b) used in a manner that is consistent with federal or state licensing or certification requirements for facilities, hospitals, or programs authorized under chapter 71A.12 RCW.

An Example of a Mechanical Restraint

Jenny lives in an adult family home (AFH).  Jenny frequently falls out of bed and has hurt herself in the past.  Frustrated, the AFH owner pushes Jenny’s bed against the wall and moves a low chest of drawers on the exposed side, hoping that this strategy will keep Jenny in bed.

  • RCW 74.34.020(17)] Physical restraint means the application of physical force without the use of any device, for the purpose of restraining the free movement of a vulnerable adult’s body.  “Physical restraint” does not include (a) briefly holding without undue force a vulnerable adult in order to calm or comfort him or her, or (b) holding a vulnerable adult’s hand to safely escort a resident from one area to another.

An Example of a Physical Restraint

Sarah has an intellectual disability and a diagnosed mental disorder.  She lives with her parents.  Sarah is upset that her father removed her bowl of cereal, rushing to get to an appointment.  Sarah yells and turns over her chair.  Sarah’s two grade-school age siblings are in the room and the father fears they may get hurt.  Sarah’s father tackles her, pushes her up to a corner and holds her arms, and yells for Sarah to calm down.

Additional examples of improper use of restraint may include:

  • Statements that improper use of restraints (physical, chemical, mechanical) is occurring
  • Exceptional drowsiness
  • Unusual lethargy or inability to communicate
  • Bruising on wrists, ankles, that are suspect of being tied; rope burns
  • Furniture shoved against a bed to block movement
  • Wheelchair user shoved in front of a table, unable to move
  • Putting the vulnerable adult in a room and locking the door
  • Pinning arms behind back
  • Holding a person prone or supine
  • A chair placed by a door so the vulnerable adult cannot exit
  • Taking away a walker, cane, etc.

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