CMS SOM App. A, Tag A-0159

(i) A restraint is—

(A) Any manual method, physical or mechanical device, material, or equipment that

immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head

freely; or

Interpretive Guidelines §482.13(e)(1)(i)(A)

This restraint definition applies to all uses of restraint in all hospital care settings. Under this definition,

commonly used hospital devices and other practices could meet the definition of a restraint, such as:

• Tucking a patient’s sheets in so tightly that the patient cannot move;

• Use of a “net bed” or an “enclosed bed” that prevents the patient from freely exiting the bed.

EXCEPTION: Placement of a toddler in an "enclosed" or "domed" crib;

• Use of "Freedom" splints that immobilize a patient's limb;

• Using side rails to prevent a patient from voluntarily getting out of bed; or

• Geri chairs or recliners, only if the patient cannot easily remove the restraint appliance and get

out of the chair on his or her own.

NOTE: Generally, if a patient can easily remove a device, the device would not be considered a

restraint. In this context, “easily remove” means that the manual method, device, material,

or equipment can be removed intentionally by the patient in the same manner as it was

applied by the staff (e.g., side rails are put down, not climbed over; buckles are intentionally

unbuckled; ties or knots are intentionally untied; etc.) considering the patient’s physical

condition and ability to accomplish objective (e.g., transfer to a chair, get to the bathroom in

time).

Survey Procedures §482.13(e)(1)(i)(A)

• Determine whether the hospital’s policy and procedures employ a definition or description of

what constitutes a restraint that is consistent with the regulation.

• While touring hospital units look for restraints in use. Where a restraint is in use, check the

medical record for appropriate documentation.

• Interview hospital staff to determine whether they know the definition of a restraint.