Definitions for restrictive interventions for use in Assuring Transformation

(Sometimes referred to as manual restraint)

This revised data set seeks to record incidents that meet:

1.  The MHA code of practice (2015, DH) definition of physical restraint ‘any direct physical contact where the intervener’s intention is to prevent, restrict, or subdue movement of the body, or part of the body of another and

2.  Meets all parts of the above definition of restrictive interventions and

3. That take place in one of the following positions:

Position: prone

Definition

A physical restraint in a chest down position, regardless of whether the person’s face is down or to the side.

1.  Incidents where there is no resistance from the patient, such as a guiding hand or directing a patient away from an area they are not supposed to enter, (a male patient walking towards the female toilet) should not be recorded as restraint.

2.  The intention of staff is irrelevant. If a patient is placed in, falls into, or puts themselves into any of the above positions, and the criteria for restraint to be recorded are present, the incident should be recorded as a restraint in that position.

3. The duration of the restraint is irrelevant. A restraint should be recorded if the patient is in one of the above positions, however briefly and regardless of intent.

4. Where a patient is held in order to facilitate care or a clinical procedure (sometimes referred to as clinical holding), the incident must be recorded as a restraint, provided that all criteria of the restraint definitions are present. For example, an older person with dementia may require restraint to be assisted with dressing and the use of the toilet, as there are periods during the day when communicating this need is difficult. This plan has been agreed through a ‘best interests’ meeting and relatives/carers are aware. The person lacks capacity and the use of restraint varies dependant on how the person responds to staff at the time and the level of personal care needs. Whenever possible, staff will avoid restraint and wait for an appropriate opportunity to engage, however there are times when staff must intervene due to personal hygiene issues. Whenever restraint is used, even as part of planned care, this must be recorded as a restraint.

5. It is irrelevant if a restraint is care planned. Any incident that meets all elements of the definition must be recorded.

6. The content of staff training and or provider policy is irrelevant. If a patient is placed, falls into or puts themselves in one of the above positions and the criteria for restraint are present, the incident should be recorded as a restraint.

1. Do not record PRN medication where it does not meet the criteria for a restrictive intervention.

The following practice should be recorded as seclusion.

1. A patient is locked in a seclusion room

2. A patient is locked in a bedroom

3.  A patient is placed alone in a room and prevented from leaving either by the door being locked, held shut, blocked or staff standing in the doorway preventing the patient from leaving

4. Where a patient asks to be isolated from others and is then prevented from leaving the area in which they are isolated.

The following practice should not be recorded as seclusion

1.  If a patient is being restrained by staff, they are not being secluded.

The following examples should be recorded as segregation.

1.  John is in medium secure care. Over the last 4 weeks John has assaulted other patients and several members of staff who attempted to intervene. He has previously been restrained and secluded for short periods of time. Each time John comes out of seclusion he makes threats and assaults other patients. The MDT call a meeting to discuss how best to support John and invite the specialised commissioning case manager and his advocate to attend. His families views are sought for the meeting. They decide that his behaviour presents a prolonged and continuing risk to the other patients and agree that John should be cared for away from other patients until the therapeutic interventions of staff have reduced his level of risk. They move John to the extra care area where he has an en-suite room, a small lounge area and, under the supervision of staff, access to a secure outside area.

2. John is moved to a different extra care area that does not have a separate lounge or access to outdoor space. He is still segregated.

3. Vicki is in an acute ward. Over the last 4 weeks Vicki has assaulted other patients and several members of staff who attempted to intervene. She has previously been restrained and secluded for short periods of time. Each time Vicki comes out of seclusion she assaults other patients. The multi-disciplinary team decides to care for Vicki away from other patients by partitioning off part of the ward. The commissioning authority is not consulted, nor is Diane’s advocate or her family.

4. Marie has been in a variety of care settings for the last 15 years. A number of different diagnoses have been suggested in addition to her being autistic. Marie becomes very distressed when she is cared for on a ward with other patients. The commissioner responsible for her care agrees an individualised package of care, where she has no interaction with other patients. Marie and her family are happy with this arrangement.