Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
Harv Rev Psychiatry. 2010 Nov-Dec;18(6):353-8. doi: 10.3109/10673229.2010.527514.
Physical restraints, such as locked-door seclusion and two- or four-point leather restraints, are frequently used in both the medical and psychiatric settings. Efforts are currently under way to reduce the use of physical restraints in psychiatric settings; various institutional, state, and federal policies are place. However, using these same restraints in the context of providing medical care for psychiatric patients is more complicated, as it is uncertain which principles and regulations apply in a particular setting. For example, is the restraint governed by the policies that regulate the psychiatric application of restraints, by those that regulate the medical application of restraints, or by both? This article reviews the principles and regulations governing the use of restraints on psychiatric patients, with specific attention to the use of restraints in providing medical treatment to that patient population. Also addressed are general principles of risk management to help avoid negative outcomes and to reduce the risk of litigation for unauthorized or unlawful restraint. A case example is used to illustrate these concepts.
身体约束，如锁门隔离和双或四点皮革约束，在医疗和精神病学环境中经常使用。目前正在努力减少精神病学环境中身体约束的使用；各种机构、州和联邦政策正在制定中。然而，在为精神病患者提供医疗护理的背景下使用这些相同的约束更加复杂，因为不确定在特定环境中适用哪些原则和规定。例如，约束是受规范精神病学应用约束的政策管辖，还是受规范医疗应用约束的政策管辖，或者两者都受管辖？本文回顾了管理对精神病患者使用约束的原则和规定，特别关注在为该患者群体提供治疗时使用约束的情况。还讨论了一般风险管理原则，以帮助避免负面结果并降低未经授权或非法约束的诉讼风险。使用案例示例来说明这些概念。
