Chemical restraint is defined as the use of any type of drug to restrict an individual’s movement or freedom. Chemical restraint may be used solely for the purpose of sedating an individual. In most cases, chemical restraint typically refers to psychopharmacological drugs, such as sedatives and anti-anxiety medications. It is illegal for nursing homes to administer chemical restraint to residents unless they are used to treat medical conditions or prevent residents from causing physical harm to themselves or other individuals. Federal and state laws aim to minimize the use of unnecessary drugs, especially chemical restraints.
Chemical Restraint Use
Chemical restraint use is highly controversial. In a nursing home setting, federal law strictly prohibits the use of chemical restraint for the sake of staff convenience, discipline, or other non-medical reasons. It may only be used in instances where a patient’s behavior jeopardizes the safety of himself or herself, or the safety of other residents or staff members. Even in these scenarios, the duration and nature of the chemical restraint must be outlined in the resident’s medical file. It is important to note that there is no current drug that has received U.S. Food and Drug Administration (FDA) approval for use as a chemical restraint. In fact, the FDA states that roughly 15,000 nursing home resident deaths each year result from unnecessary anti-psychotic use.
Types of Chemical Restraint
The primary types of chemical restraint used are psychopharmacological drugs, which impact an individual’s behavior, mood, thinking, and sensation. These drugs are known to rapidly sedate or relax a patient who behaves violently or unmanageably. Physicians and caregivers should take caution, as these drugs may pose the risk of severe side effects for patients. Patients should always be monitored during use.
Antipsychotics
Antipsychotics can be most commonly associated with chemical restraint. There are several classes of antipsychotics which may be used as chemical restraint, including atypical antipsychotics and typical, or classic antipsychotics. Common antipsychotic drugs include droperidol, haloperidol, risperidone, and olanzapine. Antipsychotics should be used with extreme care, as they may cause severe side effects. In certain cases, antipsychotics may cause life-threatening heart conditions.
Benzodiazepines
Benzodiazepines are a class of drug that can help alleviate conditions such as anxiety, seizure disorders, muscle tension, panic attack symptoms, and insomnia. Studies show that benzodiazepines are effective for controlling agitation and sedating an individual. The most common types of benzodiazepine for agitation control are lorazepam and midazolam.
Dissociative Anesthetics
Dissociative anesthetics are a type of hallucinogen. These drugs distort the patient’s perceptions of sound and sight. They also tend to dissociate, or detach individuals from their self and environment. Dissociatives work by blocking or reducing brain signals between the conscious mind and other parts of the brain. Due to the intensity of dissociative drugs, they are less commonly used than drugs such as antipsychotics and benzodiazepines.
Chemical Restraint Laws
Chemical restraint use is subject to both federal and state laws, which may vary from state to state. According to federal law, nursing home residents have the right to remain free of any chemical restraints imposed for discipline or convenience as opposed to treating a resident’s medical condition. Chemical restraints may only be used to ensure the physical safety of residents and other individuals. Additionally, consent must be given in order to use chemical restraints. The resident or resident’s representative has the right to refuse chemical restraint use, even when recommended by a physician.
Physician Order
Unless in an emergency, federal law states that chemical restraint may only be used upon the written order of a licensed physician. This written order must outline the duration and the circumstances of the chemical restraint. The order then appears on the resident’s medical record within the nursing home. In emergencies, chemical restraint may be used without physician order except in cases where the nursing home was previously notified that the chemical restraint in question is unacceptable for any circumstance. State law may require that a physician is consulted immediately after administration of chemical restraint in an emergency situation.
Sources:
Hughes, Rhidian. “Chemical restraint in nursing older people.” Nursing Older People Apr. 2008: 33+. Academic OneFile. Web. 1 Mar. 2014.
Kidder, Samuel W. “The Chemical Restraint Debate.” Geriatric Times 1 May 2002: 40. Academic OneFile. Web. 1 Mar. 2014.
Yu, Chieh-Chen, and Hui-Chi Huang. “Chemical Restraint and Nursing Care in the Intensive Care Unit. [Chinese].” Journal of Nursing 57.6 (2010): 83-88. CINAHL Plus with Full Text. Web. 1 Mar. 2014.