I’m doing some research into restraint-compatible beds for crisis stabilization. We’re getting more requests from facilities for (some) beds within the space to support restraint use, but I’m having trouble finding any established standards or evidence-based guidance on recommended restraint-point placement, load requirements, or test methods for bed-based restraint systems.
For those who have worked on BH projects where restraint capability was required:
Were there specific guidelines or facility-driven criteria that informed placement?
Did you reference any published standards or research?
Additionally, if anyone is aware of guidelines, research, or best-practice references that address the above, I’d be grateful for any direction.
I don’t have evidence that would support a specific quantity, and I have found typically stakeholders rely on their own internal data for that determination. However, I have seen an approach that could be considered in lieu of permanently locating restraint beds in a space.
One organization I worked with designed a custom polycarbonate restraint board that fits between the platform bed and the mattress, with restraint hooks positioned just outside the mattress sides. This allows staff to deploy it only when needed while avoiding the permanent ligature risk and the intimidating appearance of fixed restraint loops on some beds. They would need a storage location for the boards, and would need to determine the necessary quantity. Most instances I have seen they only need one, if any.
Our organization operates facilities across nearly the full spectrum of care, and restraint is always the last possible intervention. Our preferred sequence is to use a de-stimulation (de-stim) room first, followed by seclusion, and only then restraint when absolutely necessary. Typically, restraint requirements and configurations are dictated by state licensing regulations. Seclusion is also generally prohibited in any area that has not been specifically designed and approved for that purpose. For example, we cannot perform seclusion or restraint in a standard patient room.
In some of our less ideal environments, limited space forces the de-stim, seclusion, and restraint functions into a single room. In those cases, the visible presence of a dedicated restraint bed can negatively impact clients. It discourages use of the room for de-stim purposes and can be highly triggering for individuals with trauma histories from repeated restraint experiences.
This is why I find the earlier suggestion particularly appealing: using a regular bed that functions for de-stim or seclusion but can be converted for restraint by removing the mattress and utilizing an integrated board system. It’s a thoughtful approach that maintains flexibility. I will have to ponder that further.
In the past, we have used a wide variety of seclusion beds, and our staff consistently prefer the Durmaxx model from Human Restrain. Mainly due to the placement and design of the restraint rings and the color-coded (green for “grass”/lower body, blue for “sky”/upper body) non-locking polyurethane straps, which are easier to clean than cloth. We also prefer to center the bed in the room whenever possible, as full access from all sides improves safety for both staff and clients during restraint events. We do typically anchor the bed because the mobile beds can be used as battering rams during seclusion only events. And some units are so small that a bed removed from the room must be left in the hall. Dare I say, creating an egress violation if a relevant AJH happens to drop by. Centering the bed can be challenging in smaller rooms where the AHJ requires ADA-compliant clearances on at least one side.
Let’s just say I may know someone who has gotten creative after inspections in the past and moved the bed. But I can’t seem to recall his name at the moment. He might also be the same person who has strong feelings about fold-down shower chairs creating unnecessary ligature risks in facilities where ADA needs are rare and can be safely met with removable equipment instead. He might even have removed such risks after inspections. I’ll let you know if I can recall his name.
Anyway, I hope someone finds this information helpful.
This was incredibly helpful - thank you so much for takin the time to post this thoughtful response.
I also thought Melanie’s suggestion on the temporary solution would solve a variety of issues facilities are faced with, I appreciate your feedback on practical uses in smaller facilities. Thanks for sharing.
I really appreciate the feedback from all. Thank you!