08/05/2012 - Restraining patients

#NurChat to discuss "Restraining patients" - 08/05/2012 8pm

@nursiedeb tweeted the suggestion for this NurChat – the restraint of patients – along with a link to a news story “Frail cancer patient died in handcuffs after nurses called police” – Mirror. This story outlines how Mr Philmore Mills was restrained by police and guards who were called following an episode agitated behaviour, Mr Mills died whilst being restrained. This story throws up interesting debate about when it is acceptable to restrain a patient and is it acceptable for abusive and agitated patients to be restrained in this way?

The RCNs advice “Lets talk about restraint” states that restraint can be described as “restricting movement or restricting liberty” and they go onto suggest that restraint falls into the following categories:

• Physical restraint – Holding, moving or blocking a person
• Mechanical restraint – Involving the use of equipment
• Technological surveillance – Tagging, CCTV, pressure pads
• Chemical restraint – Involving the use of medication
• Psychological restraint- constantly telling someone not to do something, deprivation of lifestyle choices.  

So given that restraint comes in many different forms when is it acceptable, legal and safe to restrain a patient?  Under what circumstances should we consider it ?

Thanks goes to @nursiedeb for suggesting this discussion

Click on the picture to download a printable/ emailable PDF to share with colleagues

Below are some links that you may find useful as background reading prior to the discussion?

Frail cancer patient died in handcuffs after nurses called the police - Mirror 

Decisions on bed rails must not be made through emotive arguments - Nursing Times

Nurses do care deeply about patient safety which is why they don't use restraining vests - Nursing Times

Why do UK nurses consider restraints unacceptable? - Nursing Times

Lets talk about restraint - RCN

Dementia patients denied basic rights says damning report - Daily Mail

Second annual report on the deprivation of liberty safeguards published today - CQC

Summary by Teresa Chinn RN

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Post Chat Summary 

This #NurChat started by asking participants how they would define restraint? Some defined it as sedation and physical restraint and others as limitations on ability to move freely, all agreed throughout the debate that restraint was not just physical.

It was raised that physical restraint may be illegal but it was then confirmed that if trained in control and restraint and if you are physically endangered it is not illegal.

Chemical restraint – the use of medication was discussed in depth.  Concerns were expressed that this from of restraint is not always questioned. It was expressed that sometimes chemical restraint may be better employed than physical but the point was then raised that chemical restraint can often lead to more episodes of challenging behaviour. The use of antiphychotics in the elderly was discussed and it was mentioned that CQC and the institute of innovation and improvement have helped to reduce the misuse to these in long term care settings.

There was a lot of empathy expressed for the person undergoing the restraint; Nurchatters agreed how terrifying it must be for the individual undergoing restraint of any sort.

NurChat asked about the use of everyday nursing objects to restrain …tables and bed rails? Participants agreed that these objects are used everyday but each patient should be treated individually and any restraint should involve team discussions.  The discussion progressed to the patient safety risks of bed rails and how much safer it is to nurse these pts on a mattress on the floor.

NurChat asked about prisoners in hospitals and whether it is acceptable to restrain them? NurChatters expressed confusion over why sedated and ventilated patient/prisoners are sometimes restrained - @MentalHelathCop a police inspector joined the chat and stated that communication is always key and it depends on the prisoner and medical issue, and raised the point that even a sedated patient may come round and be violent.

Training was mentioned and it was voiced that often only accident and emergency staff were trained in control and restraint in general settings, it was also raised that maybe mandatory yearly training would be beneficial to all nurses.

To conclude the discussion NurChat asked what the key principles were that participants could take away to ensure patient dignity and safety when restraint is used? Constant re-evaluation, regular assessment, MDT input and training were all seen as important.  

The links listed below were shared during the chat :

@MayboLimited: Good debate hosted by @NurChattonight. Many of you may find this guidance doc helpful :http://t.co/2d0iPNSl #nurchat

Bartontd #nurchat Late to the party - Deprivation of Liberty (DOL) http://t.co/LZGYFClL have we considered DOL in relation to restraint principles

Summary by Teresa Chinn RN 



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Chat Transcript (via Storify)