Restraint as a Last Resort

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

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 

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