Management of patients requiring Temporary Restrain

Any action, word or deed that is used for the purpose or intent of restricting the free movement of another

person.

Restrain may constitute an imposition on a person‘s rights and dignity and should only be used as a last resort for the shortest possible time and for the purpose of promoting and maintaining a person‘s health and wellbeing, or in the short term, the health and wellbeing of others. Restrain should not be used as a punishment or threat; as part of a regular treatment programme or because of shortage of staff. In certain circumstances when other measures have failed, restraint may be used. Restrain of a Voluntary patient for a short period per say does not warrant consideration for a temporary detention.

Restraining should be actively discouraged and only used if absolutely necessary, and then be limited to the minimal period possible. For example where: 1. Patient is not responding to the maximum recommended dose of medications used in acute disturbed behaviour

2. Further administration of antipsychotics/ benzodiazepines is likely to cause adverse medical/ physical consequences 3. Preservation of a lifesaving invasive line (i.e. IV Cannula, Urine Catheter, NG Tube, Neck Line)

If ward Nursing Officers on duty decide that staff or patients are at risk of violence and de-escalation techniques have failed to calm the patient, then they may restrain the patient after getting verbal approval from the On Call Medical Officer. Once restraint the following steps should be followed. Mechanical Restraining of patients should be done in a humane manner with minimum discomfort to the patient and highest regard to safety. 1. The On Call Medical Officer should come and assess the patient and consider rapid tranquilization and/or duration of restraint 2. A note must be made in the BHT by Nursing Officers and Medical Officer 3. Nursing Officers should inform to Special Grade Nursing Officers in their routine reporting system 4. Medical Officers need to keep the Consultant/ Senior Registrar updated

1. A restraint patient warrant close observation and monitoring 2. Level of Close monitoring to be decided by Medical Staff and carried out by nursing officers with the help of support staff 3. A trained Nursing Officer should be within sight and sound of patients who are being restrained so that they can observe the patient until restraints can be removed 4. Mouth Care, Bladder Care, Bowel Care should be attended to. 5. Harmful behaviour from other patients should be averted at all times. 6. Patient‘s dignity and respect should be ensured 7. Vital signs and Hydration should be monitored and maintained