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absolutely necessary during the conduct of a specific medical or surgical procedure, or only if

absolutely necessary for client protection during the time that a medical condition exists.

Guidance §483.450(d)(1)(iii)

Physical restraint during medical procedures must be utilized only when absolutely necessary

and be used as a last resort in order for the facility or practitioners to deliver needed medical

care to the client. The restraint must be released as soon as the medical procedure is

completed unless it is necessary to continue restraint for a longer period of time to continue to

deliver care or to prevent the client from displacing tubes or dressings. These restraints may

only be used as long as the physician indicates them to be necessary.

For instances where physical restraint are used by the facility or a practitioner during a medical

procedure, the client record and interviews should verify that less restrictive measures were

attempted before using physical restraint and verify whether any injuries occurred during the

use of the physical restraint. Written orders by medical personnel for the application of a

physical restraint should include the reason that the restraint is necessary, the type of restraint

to be used and the length of time the restraint will be applied.

A restraint device used to prevent a client engaging in self-injurious behavior is not considered a

restraint for medical condition.

§483.450(d)(2) Authorizations to use or extend restraints as an emergency measure must be:

Guidance §483.450(d)(2)

Facility policies should list who in the facility is allowed to authorize the emergency use of

restraints or to extend the use of an emergency restraint, and the training that is required for

those persons who may authorize. Documentation in the client record in those instances should

confirm that the facility follows that policy.