What is the preferred overarching principle guiding restraints use?

• A. Strive for constant physical restraint
• B. Use maximal force to prevent danger
• C. Apply restraints immediately for all patients
• D. Use the least restrictive means consistent with safety

Answer: (D)

The main idea is to use the least restrictive means that still keep people safe. This means starting with the gentlest, least intrusive approaches—like de-escalation, calm communication, reducing environmental triggers, close observation, and involving support people—before considering any physical restraints. Only if there is imminent danger and less intrusive options have been tried or are not feasible should more restrictive measures be used, and even then they should be applied briefly, be regularly reassessed, and be removed as soon as safety allows. This approach protects patient rights, minimizes both physical and psychological harm, and aligns with ethical and professional standards.

Restraints should not be constant, universal, or used with maximal force. Those practices are inappropriate and increase risk and harm. The focus is always on tailoring the response to the individual’s situation and using the least restrictive option necessary to maintain safety.