While the use of restraints is seen as a last resort inpediatric practice, it is the responsibility of the RN to use effective decisionmakingtoolssuch as algorithms to effectively determine when Background PEDIATRIC PATIENTS HAVE unique safety needs based on their developmental age. Patient rights related to restraints delineate that healthcare workers use alternative methods to reduce the use of restraints whenever possible. Examples of alternative methods include family member presence, the use of sitters, distraction, and placing the patient near the nurses' station. When alternative methods are deemed ineffective or the actions of the patient indicate immediate need for restraints, the least restrictive type of restraint should be utilized and only as a last resort. Additionally, restraints should be removed at the earliest opportunity. The importance of de-escalation cannot be underestimated. The Crisis Prevention Institute (2015) stresses the devices arebeingused as restraints. Patient/ family education help to insure safe use of restraints. importance of learning the skill of empathic listening. As Stephen Covey would say, “Seek first to understand, then be understood” by giving the person undivided attention; be nonjudgmental; focus on the person's feelings, not just the facts; allow silence; and use restatement to clarify messages. De-escalation skills must be practiced by staff on a regular basis due in part because of how staff communicate with each other and socially (texting, all forms of social media, documenting online) which may be leaving patients with the sense of a lack of focus on their needs (Dufresne, 2015). Restraint use is not without risk. The Joint Commission sentinel event restraint related events data (2015) from 2004-Q22015 notes a total of 128 events. Injuries and deaths have occurred while patients are in restraints. The risk of death and injuries while using restraints has provided the regulatory