護理長進行病房巡視時觀察到一位 73 歲患有譫妄與右側偏癱的男性。病患正在接受靜脈抗生素治療。雖然他的病床處於最低位置，但是床的四個床欄全部都被拉升到最高，且他正穿著一件背心約束帶。約束背心的帶子被用標準死結緊緊地綁在不可動的床架上。下列哪些情況代表了嚴重的約束安全違規？（多選題）
The charge nurse conducts unit rounds and observes a 73-year-old male with delirium and right-sided hemiparesis. The patient is receiving IV antibiotics. His bed is in the lowest position, all four side rails are fully raised, and he is wearing a vest restraint. The vest straps are tied securely with standard square knots to the immovable bed frame. Which actions represent severe safety violations regarding the use of restraints? (Select all that apply.)
- ALeaving the bed in the lowest possible position while the patient is restrained.在病患被約束時將病床保持在最低可能位置。
- BRaising all four side rails consecutively atop the vest application.✓ 正解在背心約束帶上方連續拉起四個床欄。
- CTying the vest straps to the rigid, immovable portion of the bed frame.將約束帶綁在床架堅固且不可移動的部分。
- DUtilizing a vest (jacket) restraint for a patient attempting to dislodge a peripheral IV line.✓ 正解對試圖拔除周邊靜脈留置針的病患使用背心（外套式）約束帶。
- ESecuring the restraint straps using a tightly tied standard square knot.✓ 正解使用緊繃的標準平結來固定約束帶。
本題測驗約束安全的違規糾正。第一、拉起全部四側床欄本身就已構成法律定義的「約束」，病患若因恐慌翻越，墜落致死機率極高（選項B違規）。第二、背心約束帶（Vest restraint）極為危險，極易因滑動勒住呼吸道導致窒息致死；對於防止拔除周邊點滴（IV line），應採用最低限制作法，例如衣袖遮蓋或軟式手套（Mittens）而非使用高致命風險的背心（選項D違規）。第三、所有約束帶必須綁成單向快速解開的活結（Quick-release knot 或 Slip knot），絕不能綁死結（Square knot），以免發生火災或急救時無法迅速解除（選項E違規）。選項C（將帶子綁在床架上）而非會移動的床欄上是正確的做法。選項A（將床放最低）以防萬一掉落可以減緩衝擊，是正確的防護觀念。
Raising all four side rails constitutes an illegal restraint and poses a severe fall risk if the patient attempts to climb over. Vest restraints are hazardous due to asphyxiation risks, and standard square knots prevent rapid emergency release; quick-release knots are required.
台灣目前因為長照安養考量，部分安養機構依然偶爾看得到胸部或背心保護帶的使用；然而在美國，因為過往曾發生大量吊死在床邊的醫療糾紛，除了精神科強制作為外，一般醫療機構幾乎已全面淘汰 Jacket/Vest restraint，且為法規考點重鎮。