Least Restraint Programs

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Least Restraint Programs

• Presented by
• Shirley L Robinson
• Leisureworld North Bay Family Council

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Definition Policy Direction
Policy Direction Least Restraint Least restraint
means all possible alternative interventions are
exhausted before deciding to use a restraint.
This requires assessment and analysis of what is
causing the behaviour. Most behaviour has
meaning. When the reason for the behaviour is
identified, interventions can be planned to
resolve whatever difficulty the client is having
that contributes to the consideration of
restraint use. For example, if a client has
poor balance or is frequently falling,
interventions, such as giving the client a
walker, can be developed to help protect the
clients safety while allowing freedom of
mobility. A policy of least restraint indicates
that other interventions have been considered
and/or implemented to address the behaviour that
is interfering with client safety.

• What are Restraints?
• Restraints are physical, chemical or
  environmental
• measures used to control the physical or
• behavioural activity of a person or a portion of
• his/her body.
• Physical restraints limit a clients movement.
• Devices such as a table fixed to a chair, tilt
  wheelchair or a bed rail that cannot be opened by
  the client,
• are physical restraints. Environmental restraints
• control a clients mobility.
• Examples include a secure unit or garden,
  seclusion or a timeout room. Chemical restraints
  are any form of psychoactive medication used, not
  to treat illness, but to intentionally inhibit a
  particular behaviour or movement.

College of Nurses of Ontario Practice
Standard Restraints
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Scenario A nurse in a long-term care facility is
admitting a client who has been transferred from
a local hospital. The facility has a least
restraint policy and for the past year has used
no restraints. It has a risk assessment protocol
used on admission to help staff determine an
appropriate plan of care that identifies
behaviours that may lead to consideration of
restraint use. Since implementing a least
restraint policy, the facility has found that
falls have not increased. The falls that have
occurred have resulted in significantly less
injury. Additionally, the incident of skin
breakdown has declined by 50 percent. The family
is insisting that their mother be restrained to
protect her safety. They tell the nurse that if
they do not restrain their mother and she falls,
they will initiate legal action. Discuss
ion This situation, like many involving the use
of restraints, is an ethical dilemma. While
nurses respect client choice, limits do exist. As
explained in the Ethics practice standard, client
choice might be limited by policies that promote
health or by the resources available in a
particular situation. When clients request nurses
to perform an act that may cause serious harm,
nurses need to inform clients in a non-judgmental
manner of the potential risks and harm associated
with the practice. The nurse in this scenario
needs to explore the implications of the request.
The family believes that if no restraint is used,
their mothers safety will be jeopardized. The
nurse is able to provide education about the
risks of restraint use and the alternatives
available. If the family continues to request
that restraints be used, the nurse respects the
familys choice but needs to explain that because
the facility has a no restraints policy, it does
not have restraints available or the resources to
use restraints safely. Knowing this information,
the family can then make an informed decision
about where to place their mother. Client and
family needs are best met when these discussions
occur before the admission takes place.
College of Nurses of Ontario Practice
Standard Restraints
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T eresa Malotte, RN Assistant Director of
Care

• When first educated as management, rounds were
  done through the building and time was spent
  with the staff while they were on the units.
  Groups discussions were held about 15 - 20 min to
  discuss the changes as well as the policy, and
  each staff then signed their name to education
  sheets. Tracking was done to indicate who
  received the info.
• A lot of one on one education was provided to
  staff on the topic. Information was covered at
  staff meetings and brought oo our charge nurse
  meetings as well. Quarterly are audits were done
  at the beginning, but only a percentage, now we
  do them all.
•  
• A review is done all the charts for those
  residents who have restraints. We ensure the
  consents and doctor orders are complete and
  current. We also check that the documentation is
  being done correctly. Our night staff check the
  restraint flow sheets and leave a memo for follow
  up. The managers then follow up with staff
  involved.

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Friday April 3, 2009 -- Camille Jensen, Writer
Online Production Editor (axiomnews.ca)A
new video on Leisureworlds policy to minimize
restraints in its 26 long-term care homes is
being created in an effort to educate families
on the importance of eliminating the use of
restrictive devices.Developed by the education
department in collaboration with a number of
Leisureworld homes, the video will dispel myths
about the safety of restraints and showcase the
more proactive approaches for resident
safety.Beverly Zangari, staff educator with
Preferred Health Care Services which provides
education to Leisureworld, says the organization
has adopted a least restraint minimization policy
and wants families to be aware of some of the
negative implications of restraints. The video
is encouraging greater communication with the
resident's family to help Leisureworld staff
learn more about the residents previous habits
that can be incorporated into their care
plan. The filming of the video took place at
five Leisureworld homes Richmond Hill,
Scarborough, Tullamore, OConner Court and St.
George and features directors of administration
and care, front-line staff and family members
sharing their experiences on the subject. The
video is going to give many, many sides of the
story of why zero restraint or restraint
reduction is the goal of Leisureworld and making
sure at the same time that the resident is as
safe as possible. Ruth Ramirez, communications
specialist for Preferred Health Care Services and
Leisureworld, produced the film and says the many
testimonials gathered will send a powerful
message on the need to find other ways to support
residents.Once completed, Ramirez says the
video will be used with families and at family
council to help more people understand the need
to decrease the use of restraints. Used by
permission received from C. Jensen axiomnews.ca
Apr.23/09
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End of Presentation

• Thank you for the opportunity to share this
  information with all of you!

For more information and additional articles see
our back info table for copies of more Least
Restraint Articles profiled in the March 2009
Ontario Long Term Care Magazine. Thank you to
OLTCA for permission to copy. You can also go
the OLTCA Website if you wish to see contents of
all of the March 2009 Magazine. www.oltca.com
College of Nurses of Ontario Practice
Standard Restraints