CIHQ-ARS Blog

One of the most common restraint questions asked by a hospital during survey; "Are hand mitts considered restraint?" The answer is "it depends"!!

The first step is to determine what type of hand mitts you will place on the patient and how you will utilize them. There are several types of hand mitts that would not be considered a restraint. However, pinning or attaching those hand mitts to the bed or using a wrist restraint in addition with the hand mitts would meet the definition of a restraint by CMS. Therefore, the requirements would apply, and hospitals would need to follow the regulatory requirements for restraints.

Another example, if the mitts are applied so tightly that the patient’s hands or fingers are immobilized, or the hand mitts are so bulky they restrict the patient’s ability to use their hands, these too would meet the definition of restraints and the CMS requirement would apply.

For the sake of this discussion, let's say that the patient was placed in hand mitts because they were picking at their dressings which may potentially cause an increase chance to develop a wound infection. The patient still has the ability to move their fingers to eat and could also remove the hand mitts if needed. This situation would not be considered a restraint.

However, if the patient continuously removed the hand mitts, still having the ability to pick at their dressing and you tie them to the bed to prevent a potential hospital acquired infection, this then would be considered a restraint and the requirement would apply. Additionally, if you decided to change the hand mitts to bulky mitts and the patient is not able to use their hands or fingers freely, this too shall be considered a restraint.

Remember: CMS states that all patients have the right to be free from restraints, of any form, and not be used as a means of coercion, discipline, convenience, or retaliation by staff. Restraints may only be used to ensure the immediate physical safety of the patient, a staff member, or others, and must be discontinued at the earliest possible time.

• Patients have a right to be free from restraint and seclusion
• All forms of restraint should be used as a last resort
• Restraint and seclusion must be based on orders from the physician
• The patient must be monitored closely to prevent adverse outcomes

Just a few alternatives you may want to think of before applying hand mitts to your patient:

• Re-orientation
• Limit setting
• Increased observation and monitoring
• Use of a sitter
• Change in the patient’s physical environment
• Review and modification of medication regimens

The use of a hand mitt as a restraint intervention should be reflected in the patient’s plan of care or treatment plan based on an assessment and evaluation of the patient. The plan of care or treatment plan should be reviewed and updated in writing within 24 hours following the initiation of restraint.

Keep in mind that CMS does not name each device or describe every situation in their definition of physical restraint. It does define a restraint as a device that can be used to immobilize or reduce the ability of the patient to move his or her arms, legs, body, or head freely; it promotes looking at each situation on a case-by-case basis. This will help your staff develop the best plan of care for each individual patient when planning what type of hand mitt will be used for the safety of the patient and to protect the integrity of lines, dressings, and tubes.

References
CMS Conditions of Participation for Acute Care Hospitals, §482.13(e)(1)(i)(C)