Best Practices for Managing Restrictive Practices
Managing restrictive practices is a crucial aspect of providing care, especially in environments like aged care facilities. Restrictive practices refer to interventions or actions that limit the rights or freedom of movement of an individual. These practices are generally divided into five types, chemical, environmental, physical, mechanical, and seclusion. Understanding and managing these practices effectively is essential to ensure the safety and dignity of individuals under care. In this article, we'll explore best practices for managing restrictive practices, focusing on aged care settings.
Note, while this article focuses mainly on aged care settings, similar principles apply in mental health facilities. However, restrictive practices in mental health are governed by a separate framework, including the Mental Health and Wellbeing Act 2022 (Vic). Under this legislation, restrictive interventions such as seclusion, bodily restraint, or chemical restraint can only be used when immediately necessary to prevent serious and imminent harm, must be authorised and reported to the Chief Psychiatrist, and are subject to strict oversight and human rights safeguards.
Restrictive practices are used in various care settings, including aged care, to manage behaviours that may pose risks to the individual or others. However, they should always be used as a last resort and in the least restrictive manner possible. Let's delve into the different types of restrictive practices.
The Five Types of Restrictive Practices
1) Chemical Restraint, involves the use of medication to influence a person's behavior. In aged care, chemical restraint should be carefully managed and regularly reviewed to ensure it remains necessary and appropriate. Under the Quality of Care Principles 2014 (Cth), chemical restraint can only be used under a valid clinical order by a medical practitioner or nurse practitioner, with consent sought where possible and documented in the care plan.
2) Environmental Restraint, refers to modifications to the environment to restrict movement, such as locked doors or gates. Environmental restraint in aged care must be used judiciously to balance safety with freedom of movement.
3) Physical Restraint, involves physical force used to prevent, restrict, or subdue movement, often involves holding a person to prevent harm. Physical restraint in aged care should always be used as a last resort and with the utmost care.
4) Mechanical Restraint is the use of devices, such as belts or straps, to limit a person's movement. Mechanical restraints should be carefully considered and monitored to avoid any physical harm. In Victoria, the use of mechanical restraints may require authorisation from the Senior Practitioner Victoria and must be part of a formal behaviour support plan.
5) Seclusion is isolating a person in a room or area from which they cannot exit freely. Seclusion should be applied sparingly and under strict conditions to ensure the individual's well-being. Seclusion is highly restricted in Victoria and generally requires prior authorisation by the Senior Practitioner Victoria. It must be demonstrably necessary, proportionate, and the least restrictive option.
Best Practices for Managing Restrictive Practices
Managing restrictive practices effectively requires a comprehensive approach, prioritising the rights and dignity of individuals while ensuring their safety. Here are some best practices.
Conduct Thorough Assessments
Before implementing any restrictive practice, it's crucial to conduct a thorough assessment of the individual's needs and the risks they pose to themselves or others. This assessment should consider:
● The individual's medical history
● Behavioural patterns
● Potential triggers for challenging behaviour
● The least restrictive options available
Develop Individualised Care Plans
Each individual should have a personalised care plan that outlines the specific restrictive practices used, their justification, and how they will be monitored and reviewed. Care plans should include:
● Clear objectives for the use of restrictive practices
● Steps to reduce or eliminate the need for restrictive practices
● Regular review and adjustment based on the individual's progress
Prioritise De-escalation Techniques
Before resorting to restrictive practices, caregivers should employ de-escalation techniques to manage challenging behaviours. These techniques may include:
● Verbal communication to calm the individual
● Redirecting the individual's focus
● Providing a safe and quiet space to reduce sensory overload
Ensure Staff Training
All staff members should receive training on the appropriate use of restrictive practices, including:
● Understanding the legal and ethical implications
● Recognising signs of distress or discomfort in individuals
● Implementing de-escalation strategies effectively
● Monitoring and documenting the use of restrictive practices
Regularly Review and Monitor Practices
Restrictive practices should be regularly reviewed to ensure they remain necessary and appropriate. Monitoring should include:
● Regular check-ins with the individual and their family or advocates
● Documentation of any incidents requiring restrictive practices
● Evaluation of the effectiveness and impact of the practices
Engage with Families and Advocates
Involving families and advocates in the decision-making process ensures transparency and supports the individual's rights. Families should be informed about:
● The types of restrictive practices used
● The reasons for their implementation
● Any changes to the care plan or practices
Adhere to Regulatory Guidelines
In Victoria, restrictive practices may require authorisation under the Disability Act 2006 (Vic) and oversight by the Senior Practitioner. Additionally, certain uses may need to be reported to the Aged Care Quality and Safety Commission (ACQSC).All restrictive practices must comply with relevant regulations and guidelines. This includes:
● Following the regulated restrictive practices guide for your practice
● Understanding the legal requirements for documentation and reporting
● Ensuring practices align with the rights and dignity of individuals
Reducing the Need for Restrictive Practices
While restrictive practices may sometimes be necessary, the goal should always be to reduce their use. Strategies to achieve this include:
● Implementing person-centered care approaches
● Enhancing communication with individuals to understand their needs and preferences
● Creating a supportive and stimulating environment that reduces triggers for challenging behaviour
Conclusion
In Victoria, restrictive practices must also comply with the Charter of Human Rights and Responsibilities Act 2006 (Vic), ensuring that any limitation on rights is necessary, proportionate, and the least restrictive means available.
Managing restrictive practices in aged care requires a delicate balance between ensuring safety and respecting individual rights. By following best practices, care providers can minimise the use of restrictive practices and promote a more dignified and person-centered approach to care. It's essential to continually assess, review, and adapt strategies to meet the evolving needs of individuals in care, always prioritizing their well-being and autonomy.
Awash Prasad
Founder & Principal Lawyer
NorthBridge Legal
