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restraint

use of mechanical restraints

Introduction

  • restrictive interventions include:
    • seclusion
    • mechanical restraint
    • physical restraint
  • mechanical restraint is the use of mechanical devices in the restriction of movement against the patient's will to allow safer care of a patient when this is the least restrictive option available at that time to achieve safety, it includes:
    • type 1 mechanical restraints:
      • padded limb control bracelets used to secure a person’s hands and/or feet to a bed or trolley
      • 2 point restraint is generally defined as wrists only
    • type 2 mechanical restraints:
      • Beds with both rails raised, prohibiting free movement, excluding:
        • Rails on trolleys during transport.
        • For up to 4 hours post sedation.
        • Patients in the Intensive Care Unit when documented as clinically necessary.
        • Patients with suspected spinal injury
      • Chairs with table inserts
      • Over bed tables placed in front of the patient with the intent of restricting patient movement
      • Tilting and tub chairs or chairs that are difficult to get out of (e.g. bean bags, water chairs and deep chairs)
      • Commercially available mittens
  • for the purposes of this discussion, mechanical restraint excludes:
    • the wrapping of a child for a necessary medical procedure where it is deemed necessary
    • utilisation of a splint and tubigrip over a child’s hand to prevent interference with a IV line or nasogastric tube
  • in Victoria, mechanical restraints may be utilized either under:
    • the Mental Health Act 2014 Victoria which has very specific processes and documentation requirements, or,
    • as a Duty of Care if the patient is not under the MH Act, and for this, most hospitals will also require appropriate documentation to justify its use
  • the general principles of using mechanical restraint are:
    • to minimize its use, used as a last resort and in the least restrictive manner and alternative strategies MUST be attempted and/or considered prior to making a decision to mechanically restrain a patient,
    • to maintain patient dignity which should be respected and promoted at all times,
    • to comply with legal and ethical standards,
    • to ensure risks of restraint are minimized (this also generally requires that specifically trained “security” officers apply Type 1 restraints),
    • to ensure regular nursing and medical review (nursing obs every 15 minutes and 1:1 nursing if Type 1 restraints),
    • to terminate use of restraints as early as possible (this also generally requires that specifically trained “security” officers remove Type 1 restraints)
    • Prisoners in Manacles/Metal Shackles or detainees from a Detention Centre in handcuffs – must not be removed and substituted with hospital Type 1 Mechanical Restraints unless required for a medical procedure.
  • As with any other medical treatment, consent must be obtained prior to use of mechanical restraints.
  • The exceptions to this are:

alternate strategies to potentially avoid use of restraints

  • these should be considered as options where applicable:
    • de-escalation, reassurance and communication
    • determine and address underlying cause (eg. pain, urinary retention, etc)
    • review any medical devices and remove any that are unnecessary
    • modify environment to reduce stimulation and improve orientation if delirium is the issue
    • diversional activities
    • increased supervision - use of a “special” 1:1 carer, or moving closer to nursing station
    • other strategies to reduce falls risk
    • pharmacologic strategies
restraint.txt · Last modified: 2021/03/01 17:20 by gary1