Chemical and physical restraint use in the older person
John Ellis Agens
Cite this article as: BJMP 2010;3(1):302 Download PDF
Abstract
A restraint is a device or medication that is used to restrict a patient’s voluntary movement. Reported prevalence of physical restraint varies from 7.4% to 17% use in acute care hospitals up to 37% in long term care in the United States. Prevalence of 34% psychotropic drug use in long term care facilities in the United States has been reported; but use is decreasing, probably due to regulation. Use of restraints often has an effect opposite of the intended purpose, which is to protect the patient. The risk of using a restraint must be weighed against the risk of not using one, and informed consent with proxy decision makers should occur. Comprehensive nursing assessment of problem behaviours, a physician order when instituting restraints, and documentation of failure of alternatives to restraint is required. Ignorance about the dangers of restraint use results in a sincere, but misguided, belief that one is acting in the patient’s best interest.Steps can be taken to reduce restraints before the need for restraints arises, when the need for restraints finally does arise, and while the use of restraints is ongoing.
Keywords: physical restraint, chemical restraint, aged care, antipsychotic agents, therapeutic use, psychotropic agents, treatment outcome, regulations
Comments
After I complained about one staff member, the victimisation of resident was brutal. I am a trouble maker!
Eventually, I said to my Mum, why is he sleeping all the time? He wasnt like that at home, or in the psychiatric unit for the 6 weeks before going into the Nursing home. At that point in my life I knew nothing about any of this,
Nursing Homes, Aged Care, no experience at all, I was only 30 years old. I said to my Mum, we need to ask them about his medication, and about a Doctor seeing him, maybe they are giving him new or too much medication. This had been the case, a Doctor apparantly did review his medication and after that he was not in bed asleep all of the time, but sill a lot of the time.
It came to Christmas Day, I went to see my Dad, it was also my birthday. When I walked into his room, he had his arms strapped to the arms of the chair, and only in his underwear, his big toe had been stubbed the toe nail hanging off and lots of dried up blood on his foot. I was cross, but so upset, I just wanted to get him out of there, so I asked for a wheelchair. I took him over to the beach across the road, so he could put his feet in the salt water, clean it up and the salt would do it good. I didnt feel I could speak to the staff, I was on my own, and I cant explain how hard that birthday/Christmas Day was for me. So I can speak from my experience that I believe my Dad was restrained by medication and also physically restrained. That Nursing Home is no longer there, it was demolished, Im thankful for that.
After my Dad died, and I recovered somewhat from the couple of years life was like that for all of us, I went into work in that field, Planned Activity Groups, Community Health for the next 15 years, until recently. I understand how families are so vulnerable, scared, upset, and how important it is to feel that your loved one is looked after properly.