Alternative Approaches to the Use of Restraints

This template is helpful in identifying and altering the antecedent and consequences to change behaviour.

Source: Omelan, C. (2006). CME: Approach to Managing Behavioural Disturbances in Dementia. Canadian Family Physician, February, 52, p. 193 Reprinted with permission from the Canadian Family Physician

This link takes you to the AdvantAge Ontario Website for implementation resources, you can scroll down to find a section on Minimizing Restraining and Use of Personal Assistance Services Devices (PASDs). Under this section there are documents related to: 1) Policy, procedure and training package and 2) Appendix materials, including: i) physical restraint monitoring, ii) restraint audit tool, and iii) least restraint, last resort training presentation.  

Copyright: AdvantAge Ontario 

Website: www.advantageontario.ca   

This decision tree from The Ottawa Hospital provides a visual decision making guide to determine risk and restraint alternatives.

All requests to adapt the Alternative to Restraints Decision Tree must be directed to the Ottawa Hospital, Department of Nursing Professional Practice

The Behaviour Monitoring Log from Penn Nursing Science helps determine the meaning of untoward events through examining patterns of behaviours/occurrences.

Adapted from: Strumpf, N., Robinson, E.J.P., Wagner, J.S., & Evans L.K. (1998). Restraint-Free Care: Individual Approaches for Frail Elders. New York: Springer Publishing, pp. 44-46. Reprinted with permission from Penn Nursing Science.

This tool is used to assess the residents’ level of confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects- as present or absent.

Source: Almvik, R. & Woods, P. (April 2003). Short-Term Risk Prediction. The Broset Violence Checklist. Journal of Psychiatric and Mental Health. Nursing, 10(2), pp. 236-238

Reprinted with permission from John Wiley and Sons

This tool helps the resident and caregiver discuss individualized behavioural triggers and preferred measures of response.

Reprinted with permission from St. Joseph`s Health Care. Hamilton, Ontario

These tips and interventions help caregivers to examine their own practices and best strategies to prevent escalation of behaviours.

Provided by the Milwaukee County Mental Health Division, Milwaukee, WI

Adapted from Dr. Gudeman's Interaction with Patient on Interventions with De-Escalating Patient 10/99

Practice standards are documents that help nurses understand their responsibilities and legal obligations to enable them to make safe, effective and ethical decisions when practising. This practice standard aims to help nurses understand the regulatory and legislative requirements for documentation.

This assessment tool is used primarily by mental health professionals to “estimate” a persons’ probability of violence.

Reprinted with permission from Ronald Roesch, Professor, Director of Mental Health Law and Policy Institute, Simon Fraser University

Website: http://kdouglas.wordpress.com/hcr-20/

This observation and documentation record is when chemical restraints, seclusion and/or mechanical restraint are used.

Copyright Centre for Addiction and Mental Health (2009). This material is prepared solely for internal use at CAMH. No part of this document may be reproduced in any form for publication without the permission of CAMH

Les normes d’exercice informent les infirmières de leurs responsabilités et expliquent leur rôle au public. Le présent document a pour objectif d’aider les infirmières à comprendre leurs responsabilités et à prendre des décisions en matière de contention. La contention, qu’elle soit physique, environnementale ou chimique, est un moyen controversé visant à restreindre les mouvements d’un client ou à maîtriser son comportement.

Copyright © Ordre des infirmières et infirmiers de l’Ontario, 2009.

Ordre des infirmières et infirmiers de l’Ontario. (2006).  La contention. Toronto, ON, Canada: Auteur. Récupérée de http://www.cno.org/fr/exercice-de-la-profession/normes-et-directives-professionnelles/.

This website provides information and resources about the P.I.E.C.E.S.™ program. "Putting the P.I.E.C.E.S.™ Together" represents Physical, Intellectual, Emotional, Capabilities, Environment, Social, and are the cornerstones of the philosophy and care of the P.I.E.C.E.S.™ approach.

In Ontario, Canada the Patient Restraints Minimization Act asks healthcare settings to consider alternative approaches and only use restraints as a last resort when a person is at risk of harm to themselves and/or others.

This link takes you to the website of Executive office of Health and Human Services (EOHHS) with resources on Restraint/Seclusion Reduction Initiative and Boston Medical Centre Person De-escalation Plan and Intensive Residential Program.

Website: http://www.mass.gov/eohhs/gov/departments/dmh/

This document outlines interventions that can be used with residents exhibiting signs of aggression, disorientation, frequent falls and or inappropriate behaviours.

Used with permission from Caressant Care

This tool evaluates the client risk and treatability related (i.e. violence, self-harm, suicide, absconding, substance use, self-neglect, and victimization).

Reprinted with permission from British Columbia Mental Health & Addiction Services

The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector.
The Long-Term Care Homes Act, 2007 (LTCHA) was revoked, which means it is no longer in force. The new Act also includes a new regulation.

Government of Ontario (2021) Fixing Long-Term Care Act, 2021. Toronto ( ON) retrieved from Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1 (ontario.ca)