Restraint in the Care of Older People
One of the first orders of business for the Committee for Healthy Ageing in 2014 will be a review of the AMA’s 2001 Position Statement on Restraint in the Care of Older People.
Restraints can be physical, involving the use of equipment such as ties or bedrails, or chemical, through the use of medication. In either case, the use of restraint in health care settings as a preventative intervention with no therapeutic benefit, is a complex issue. The decision to restrain requires careful assessment of the risks a patient’s behaviour poses to their own safety, and to the safety of others.
It is a topic that provokes discussion around what are seen as basic human rights, including the right to freedom of movement and liberty, as well as considerations of the dignity of the vulnerable. In these circumstances, making decisions about the best course of action can be difficult. The ultimate aim should always be the welfare and safety of the patient
The AMA’s 2001 Position Statement recognised the need for balance between a patient’s right to self-determination and the need to protect them from harm.
Since 2001, a growing body of evidence has developed regarding the adverse physical, psychological and ethical consequences of using restraints. There have also been considerable advances in guidance and tools employed across a broad spread of health care settings.
For example, in 2004, the Department of Health and Ageing released a guide document; Decision Making Tool: Responding to issues of restraint in Aged Care.
In 2005, the Australian Health Ministers’ Advisory Council (AHMAC) resolved that “reducing the use of and, where possible, eliminating, restraint and seclusion” should be one of four priority areas for national action to reduce harm in mental health care.
Since then, the annual Mental Health Services Conference has included ‘seclusion and restraint’ forums to showcase initiatives and share knowledge, with the ultimate aim of reducing the use of restraint.
Mental Health Services also funded a two-year project (the “Beacon project”) which examined international best practice in reducing the use of restraint. The project developed policies, guidelines and staff training aimed at reducing the use of restraint and seclusion in mental health care settings. It also highlighted the importance of thorough, collaborative assessments and debriefing processes to better understand the triggers that give rise to the use of restraints, and how to avoid them.
In more recent years, several Australian states and territories have developed and updated their own regulatory framework around the use of restraint in health care settings.
In Victoria, a Senior Practitioner role was established under the Disability Act 2006 (Vic) to monitor, audit and investigate restrictive interventions in disability practices in the State.
In 2009, the NSW Office of the Senior Practitioner, Ageing, Disability and Home Care released guidelines (Behaviour Support: Policy and Practice Manual) that prohibit the use of psychiatric medications as a chemical restraint.
The ACT Health Directorate released new policy in 2011 endorsing and promoting a culture that minimises the use of restraint and seeks to prevent the need for restraint.
The aim of the Committee for Healthy Ageing review is to ensure our position on the use of restraint in the care of older people reflects recent developments.
The review will look into:
• responsibilities in a decision to use restraint;
• the legal and ethical frameworks relevant to restraint;
• the circumstances in which restraint may be legally or ethically required; and
• recognising inappropriate use of restraint.
The Committee welcomes comments from members for consideration during the 2014 review.
Members can view the 2001 AMA Position Statement on Restraint in the Care of Older People at: position-statement/restraint-care-older-people-2001