Purpose
To carry out support safely, in line with best practice and with legislation, where individual Service Users may need to be restrained for their own safety or that of others.
Scope
All staff and Service Users.
Policy
Our policy is to always ensure the safety of those we care for, and where restraint may exceptionally seem necessary, we will consider the principles behind the Adults with Incapacity (Scotland) Act 2000. These state that any action must:
- Benefit the person;
Any action or decision taken must benefit the person and only be taken when that benefit cannot reasonably be achieved without it. - Be the minimum intervention required;
Any action or decision taken should be the minimum necessary to achieve the purpose. It should be the option that restricts the person’s freedom as little as possible. - Take account of the wishes of the person;
In deciding if an action or decision is to be made, and what that should be, account must be taken of the present and past wishes of the feelings of the person, as far as this may be ascertained. Some adults will be able to express their wishes and feelings clearly, even though they would not be capable of taking the action or decision which you are considering. For example, he or she may continue to have opinions about a particular item of household expenditure without being able to carry out the transaction personally. - Involve consultation with relevant others;
Take account of the views of others with an interest in the person’s welfare. The Act lists those who should be consulted whenever practicable and reasonable. It includes the person’s primary carer, nearest relative, named person, attorney or guardian (if there is one) - Encourage the person to use existing skills or develop new skills.
We will demonstrate that we have taken these into account prior to using any form of restraint for a person’s
safety and wellbeing.
DEFINITIONS
The National Care Standards describe restraint as:
- Control to prevent a person from harming themselves or other people by the use of physical means (actual or threatened laying of hands on a person to stop them carrying out a particular action);
- Mechanical means (for example, wrapping someone in a sleeping bag or strapping them to a chair);
- Environmental means (for example, using cot sides to prevent someone getting out of bed); or
- Medication (using sedative or tranquillising drugs for the symptomatic treatment of restlessness or agitated behaviour).’
The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 state that providers shall:
- ‘…provide services in a manner which respects the privacy and dignity of service users…’
- ‘…ensure that no service user is subject to restraint unless it is the only practicable means of securing the
welfare of that or any other service user and there are exceptional circumstances…’
The Care Inspectorate guidance on restraint states that care providers should do the following:
- Try to understand any behaviour that might put a person, or other people using the service, at risk
- Adopt the least restrictive way of managing those risks, using the intervention for the least amount of time required to deal with the risk
- Have assessed whether the needs of the Service User can be met by changing staff numbers or how they are deployed and whether changes to the environment could reduce the perceived risk. (This may include the layout of furniture within the building, the use of clear signage, good lighting, the form of security currently in place etc.)
- Clearly document the full details of any instance of restraint and why this is being used as a safety measure
- Have a regular review process
- Make the full meaning of restraint clear in policies and procedures
- Ensure that staff understand the use of restraint and use legislation and best practice to guide their practise
- Ensure staff know safe means of applying restraint.
The Adults With Incapacity Scotland Act 2000 defines someone as lacking capacity where they are incapable of:
- Acting on decisions; or
- Making decisions; or
- Communicating decisions; or
- Understanding decisions; or
- Retaining the memory of decisions.
In relation to any particular matter due to mental disorder or inability to communicate because of physical disability.
The Mental Welfare Commission further defines the following means of restraint:
- Direct physical restraint (holding someone);
- Direct mechanical restraint (lap belts or bedrails);
- Locking doors;
- Video surveillance;
- Passive alarms;
- Medication.
There are also indirect limits to freedom such as:
- Taking away walking aids;
- Control by staff;
- Financial controls.
Procedure
- We will ensure as a service that restraint measures are carried out in accordance with the above requirements and best practice.
- Where it appears necessary, we will ensure that staff receive regular accredited training in defusing challenging situations, using diversionary techniques, and applying restraint where necessary, safely.
- Restraint, in all cases, should very much be seen as the ‘last resort’, with other techniques and strategies always being employed before restraint is considered as an option.
- A risk-benefit analysis will be recorded in all cases of restraint.
- Restraint must be time limited and noted as such; agreed by the management in advance where possible; be properly recorded in forms which are available; and be regularly reviewed as part of the normal review process in care.
- Each episode of restraint will be discussed afterward with the people and staff concerned to ensure closure on that situation.
- Families must be aware of the restraint and in full agreement, and that agreement noted. This does not replace the requirement for the person’s own consent to restraint, where possible.
- Pre-printed “Restraint Register” forms are available from the office and must be used to ensure compliance with this policy.
- All restraint sheets must be kept in the register, and be available for inspection.