---
title: "Restraints"
url: https://mghmclean.org/residents/handbk/part2a/rest.htm
description: "· Required when patients are at substantial risk to harm themselves or others and less restrictive measures have failed."
published: 2026-08-10
updated: 2026-08-10
---

# Restraints

Published 2026-08-10

PART 3 / CH 21

On this page

1. A. Alternative Measures
2. B. Chemical Restraints
3. C. Physical Restraints

Jaime Winnick

· Required when patients are at substantial risk to harm themselves or others and less restrictive measures have failed.

## A. Alternative Measures

| 1. Redirect | talk to patient, set limits, suggest quiet time in patient’s room |
|---|---|
| 2. Offer PRNs | PO benzodiazepines, standard neuroleptics, olanzapine, risperidone, benadryl or vistaril, trazodone |
| 3. Show of force | have several staff members/ security guards present to set limits |
| 4. Locked doorseclusion | contained, less stimulating environment |

## B. Chemical Restraints

If patient is unwilling to take medications by mouth, use IM. Lower dosages should be utilized for medically compromised or elderly.

| Clinical Scenarios | Suggested Medications |
|---|---|
| agitated adult patient | Haldol 2-5mg + Ativan 1-2mg + Benadryl 50mg (all IM)Thorazine 100mg IM (risk of orthostasis)(Cogentin 1mg IM may be used instead of Benadryl)May repeat q1-2h, do not exceed Haldol 20mg, Ativan 12mg, or Benadryl 200mg in 24hIn elderly, Haldol 0.5-2mg IM +/- low dose benzo |
| mentally retarded, history of substance abuse | Haldol 5mg IM + Benadryl 50mg IM. (avoid benzodiazepines) |

## C. Physical Restraints

· On occasion, patients need to be restrained physically to protect themselves and the environment. The protocol mandated by MA state law/ DMH protocol is as follows:

RN or MD examines the patient and writes the order. MD must see patient within the first hour of a restraint. MD’s order is good for 3 hours. RN and MD can then alternate renewing the physical restraint for 3 hours at a time until the patient is released. In addition, under DMH regulations, the medical director or designee must see any patient in restraints for 8+ hours in a 24h period.

In practice, this means an MD must see patient and renew restraint order within the first hour of a restraint and every 6 hours until patient is released from restraints.