Physical Restraint

Policy Statement

This policy is intended to set out the values, principles and policies underpinning this home’s approach to physical restraint by staff. It is integral to the home’s overall approach to the safeguarding of vulnerable residents and should be read in association with related policies on aggression towards staff, rights, risks and restraint.

Definition

This home understands physical restraint to refer to the restriction of a person’s freedom without their permission. In the context of care within a nursing or residential care setting restraint could relate to:

• the use of restraint in the event of a resident or visitor becoming aggressive or behaving in a threatening manner
• the use of restraint to prevent self-harm or injury to a resident (for instance, the use of cot sides in bed, locking doors, etc)
• the use of restraint to prevent a resident from leaving the home in situations where staff are concerned as to the safety of that resident.

Restraint Policy

This home understands that restraint is illegal unless it can be demonstrated that for an individual in particular circumstances not being restrained would conflict with the duty of care of the home and that the outcome for the individual would be harm to themselves or for others.

This home considers that physical restraint represents bad practice in care and should be avoided wherever possible. Staff will use physical restraint only as a last resort or in exceptional circumstances.

Restraint will be used only where:

• the particular form of restraint has been agreed as necessary and has been entered in the residents plan of care
• the restraint is needed in an emergency situation to prevent serious physical harm to the resident or another resident.
• those involved in the intervention have received the appropriate training and supervision.

Any restraint used must be in the best interests of the person. It should be based upon the level of risk present, taking account of the person’s size, gender, age and medical conditions. It should be used for the minimum amount of time and with the least amount of intervention.

Any use of restraint must be carefully documented in the resident’s notes and reviewed. Alternative methods of care should be used wherever possible.

It is accepted that some residents can exhibit challenging behaviour at some time or another. Staff are always expected to deal with these events in a calm and professional manner. Whenever restraint is used full details must be entered in the resident’s record and the management informed of the incident. Restraint should never be used as an easy option and all staff should be aware of the residents’ legal and moral rights to freedom, dignity and autonomy at all times.

The Deprivation of Liberty Safeguards

Whenever it is identified that a resident who lacks mental capacity is being, or risks being, deprived of their liberty, an application will be made to the local authority for authorisation.

Anyone with a concern, for example, a family member, can apply to the supervisory body to trigger an assessment if they have asked the home to apply for an authorisation but it has not been done.

Each case that is referred for authorisation will be assessed by a trained Best Interests Assessor appointed by the local authority.

Where the local authority approves the care it will grant an authorisation. In such cases, a representative will be appointed to support the resident and look after their interests.

The care home, in partnership with the local authority, must then:

• make regular checks to see if the authorisation is still necessary
• remove the authorisation where it is no longer necessary
• provide the person who has an authorisation and their representative with information about the authorisation and their rights and entitlements.

Where conditions are attached to the authorisation issued, for example, steps to be taken to keep contact with family or to ensure cultural or faith-based needs are met, these will be fulfilled.

Restraint Used in Situations of Aggression or Violence

Physical and verbal aggression by a resident should be dealt with as per the home’s policy on aggression and violence and never met with hostility from staff. Physical interventions should be used only as a last resort by trained staff and to protect the rights and best interests of the resident and should be the minimum consistent with making sure that all involved are kept safe from harm.

If a member of staff is actually attacked they are permitted to use “minimum reasonable force” to defend themselves. Care should therefore be taken to ensure that minimum force is indeed used and that residents who are acting in an aggressive or threatening manner are not subject to undue restraint.

The law gives protection to people from being abused or attacked and, if a member of staff is attacked, they are allowed to use “minimum reasonable force” to defend themselves. However, staff should remember that if they restrain a violent person and injure them as a result of the amount of force they use, they could be charged for assault. Because of this risk, staff must always follow the established procedure.

Training

All new staff receive training on the policy on dealing with aggression and violence as well as this policy on physical restraint as part of their induction process.

The home provides existing staff with further training to address challenging behaviour and aggression and violence.

The home provides ongoing training so that staff can develop skills to manage and reduce unacceptable behaviour on the basis of detailed problem analyses and the selection of individualised interventions appropriate to each case. Staff are trained in a range of intervention strategies that have developed in respect of socially inappropriate behaviour. Training includes:

• de-escalation techniques
• the concept and use of “minimum force”
• approved and acceptable break away techniques
• inappropriate or unacceptable techniques.

Signed: _____________________________

Date: _____________________________

Policy review date: _____________________________

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