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Restraint as a Last Resort

On admission, assess a patient for any predisposing characteristics or precipitating factors that would place them at risk for restraint use.

Baseline: Predisposing Characteristics

Patients who are at risk for restraint use include, but are not limited to, those living with:

  • Cognitive changes, mental status changes, psychiatric conditions
  • History of traumatic experiences (e.g. physical, sexual, loss, abandonment)
  • Cultural traumas and intergenerational traumas (e.g. residential schools, trauma from slavery, experience of torture, experience of immigrants who lived in war-torn countries)
  • Communication and/or sensory impairment (e.g. aphasia, visual impairment)
  • Decreased independence (e.g. mobility, falls, incontinence, activities of daily living)
  • History of aggression and violence (e.g. assaults, damage of property, self-injury, behavioural emergency)
  • Anxiety, restlessness, wandering

Acute: Precipitating Risk Factors

There are also acute (precipitating) factors which create restraint risk, such as: 

  • Cognitive changes such as delirium (hypoactive, hyperactive or mixed), dementia, unable to remember instructions, etc. 
  • Multiple admissions, surgery and the use of sedation
  • Medications (e.g. benzodiazepines, new medications, polypharmacy, psychoactive agents)
  • Unanticipated side effects
  • Substances (e.g. alcohol or drug intoxication or withdrawal)
  • Environment (e.g. abuse, noise, temperature, lack of assistive devices, poor accessibility)
  • Unmet needs (e.g. hunger, thirst, toileting, fear, love)
  • Relocation to a new home or facility 

Assess

Use an appropriate and validated assessment tool to further explore any identified restraint risk factors. For example:

 

If a patient is admitted with a restraint order: