CMS SOM App. J, Tag W306

restraint is employed,

Guidance §483.450(d)(6)

This requirement does not apply to cases of medical restraints that are specifically ordered for

the immobilization of bones and joints during the physical healing process involved with

fractures, sprains, etc. (e.g. a broken bone immobilized by a cast or splint). See 331 483.460(c)

regarding surveillance of skin integrity during the use of medical restraints.

However, if a mechanical physical restraint is applied to an extremity to prevent a client from

removing post-operative sutures, the restraint must be released every two (2) hours for a period

of not less than ten (10) minutes in order to maintain adequate circulation.

Mechanical restraints placed on the client during sleeping hours must be medically based and

specifically ordered by a physician. There should be evidence in the client’s record why the

mechanical physical restraint is necessary during sleeping hours. While it is not necessary to

wake the client every two (2) hours to release the restraint and provide opportunity for

exercise, the staff must check the restraint frequently during the night to ensure that the

restraint is still properly applied and the client appears comfortable.