Policy on Restraints

Policy Issue

A restraint is something that restricts or controls an individual’s movement or behaviour. There are three kinds of restraints:

• Physical restraints are items, or actions that physically restrict or control movement or behaviour. They may be attached to a person’s body or create a barrier e.g., geri-chairs, hand ties, bed railings, bars, or physical holds.
• Chemical restraints are any medication used to control behaviour beyond the point of therapeutic benefit.
• Environmental restraints can include modification of an individual’s surroundings to restrict or control movement e.g., seclusion rooms, locked doors.

Research shows that restraints are unnecessary, they are not cost-effective, they create problems for staff and they can increase the behavior they are meant to control.

The emotional effects of restraints can include isolation, depression, panic, fear and anger. Social effects of restraints can include loss of dignity, independence and self-esteem. Physical effects of restraints include pressure sores, infection, incontinence and muscle atrophy. There are endless recorded cases of people who are restrained that become unable to move, incontinent and verbally disruptive.

Although the province espouses the philosophy of client-centred care, the use of restraints is being justified for the following reasons:

• the assumption that "unacceptable behaviour" must be controlled;
• lack of knowledge of alternatives; and/or
• a principle of "safety above all else".

Purpose

To ensure that people with developmental disabilities live in environments that are as restraint free as possible.

Guiding Principles

• People have the right to live in an environment that is safe, dignified and respectful.
• People’s behavior is an integral part of their communication.
• The use of restraints can be dehumanizing, invasive and life-threatening.
• The first step towards changing someone’s behaviour is to understand the reasons for it.

Background

There have been a great many studies documenting the adverse effects, both physical and mental, on people who are restrained. New studies in Canada and the United States reveal that death from the use of restraints happens all too frequently. The evidence also shows that the removal of restraints does not necessarily result in serious injuries to either patients or staff. In fact, so called "disruptive" behaviours and agitation are reduced when restraints are no longer used.

Another "myth" surrounding the removal of restraints is that it increases the need for staff time. Practice has shown that it is possible to remove restraints without increasing staffing. The time that is spent carrying out a restraint policy (e.g., regular inspection, release, exercise, monitoring), is time that could be spent implementing alternative approaches with the individual that have a more positive overall affect.

Safety is the most common justification for the use of restraints. Other reasons include that "there are no alternatives" or that restraints are necessary because of staff shortages. Some staff and family members suggest "patients don’t mind being restrained – it makes them feel secure". Administrators defend the use of restraints on the grounds that failure to restrain puts care providers and facilities at risk for legal liability.

In April 1999, the BC government passed a new regulation to the Community Care Facility Act pertaining to the use of restraints in adult licensed facilities. The new regulation says that restraints must not be used for punishment, discipline or the convenience of staff. It allows for the use of restraints only where all alternatives are exhausted, the restraint is minimal, staff are properly trained, the facility has a restraint policy and the use of the restraint is documented on the resident’s care plan. It also stipulates that the restraint can only be carried out with the consent of the resident or their substitute decision-maker and doctor.

As awareness and understanding has increased, alternatives to restraints have been developed and implemented. However in spite of these alternatives the practice of restraining people still persists.

Policy Statements

1. People with developmental disabilities have the right to live in a restraint free environment.
2. Any decision to use restraints for a person with a disability should be made and employed on the same basis and for the same therapeutic reasons as for a person without a disability.
3. Any decision to use restraints must be documented and reviewed through a monitoring process.
4. Care providers should receive mandatory training on alternatives to restraints.