Appendix C Restraint Approval and Management to Enhance Safe Restraint C.pdf

Restraint - Approval and Management to Enhance Safe Restraint
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PURPOSE

“Restraint  is  a  serious  intervention  that  requires  clinical  rationale  and  oversight.    It  is  not  a
treatment  in  itself  but  is  one  of  a  number  of  strategies  used  by  service  providers  to  limit  or
eliminate clinical risk.  Restraint should only be used in the context of ensuring, maintaining, or
enhancing the safety of the consumer, service providers, or others.”  NZS 8134.2:2008 Health
and Disability Services (Restraint Minimisation and Safe Practice) Standards (The Standard)

SCOPE

Hawke’s Bay District Health Board (HBDHB) supports the reduction in the use of restraint in all
its  forms  and  encourages  the  use  of  least  restrictive  practices  as  supported  by  NZS
8134.1:2008, Health and Disability Services (Core Standards).

HBDHB considers that restraint minimisation and safe practice in Mental Health and Addiction
Services is underpinned by ‘Recovery Principles’ and ‘Recovery’ orientated service delivery.

This  policy  applies  to  ALL  employees of HBDHB.  It sets  out HBDHB standards in relation to
the  use  of  restraint.    The  aim  is  to  minimise  the  use  of  restraint  and  to  ensure  that,  when
practised, it occurs in a safe and respectful manner.

For  the  purpose  of  this  policy  the  words  “patient/client”  wil   include  reference  to  all  patients,
clients, service users, consumers and Tangata Whaiora.

EXCLUSIONS

This policy does not apply to:


Technical  Positioning:    safe  holding  which  may  be  part  of  usual  clinical  procedures  or
clinical interventions or to briefly manage clinical symptoms


Domestic Security:  the practice of locking external doors at night for general security.


‘Locked Units’:  where a locked exit is a permanent aspect of service delivery to meet the
safety  needs  of  the  patient/client’s  who  have  been  assessed  as  needing  that  level  of
containment.


Use  of  restraint  recommended  and  applied  by  police/prison  officers  for  reasons  other
than clinical treatment, is not covered by this policy as it does not fall under the Standard
Any  restraint  implemented  on  HBDHB  grounds  by  an  outside  agency  i.e.  police,
corrections,  etc., is the responsibility of the agency implementing the restraint.  HBDHB
staff  will  need  to  continue  to  coordinate  the  provision  of  care  with  the  service  providing
the restraint.

POLICY

This  policy  sets  out  HBDHB’s  standards  in  relation  to  the  use  of  restraint.    The  aim  is  to
minimise  the  use  of  restraint  and  to  ensure  that,  when  practised,  it  occurs  in  a  safe  and
respectful manner.

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

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  Authorised  restraint  is  an  approved,  skilled  intervention  that  may  be  used  to  prevent
individuals  from  harming  themselves,  endangering  others  or  seriously  compromising  the
therapeutic environment.

  HBDHB  expect  that  restraint  to  be  used  only  after  all  less  restrictive  interventions  have
been attempted and found inadequate.

  Any form of restraint, along with outcomes must be documented in the health record and
an event report completed for each type of restraint used.

  Use  of  medication  as  a  form  of  ‘chemical  restraint’  is  in  breach  of  the  policy  and  the
Standards.

  Use of hand cuffs by DHB staff is in breach of the policy and the Standards, If a situation
arises where there is a need for such a high level of restraint then the police must be called
to  execute  the  use  of  hand  cuffs  and  are  responsible  for  their  continued  use  and
monitoring.

  The use of restraint shall:
-
Promote safety of all involved
-
Be based on effective risk assessment and decision making
-
Focus on de-escalation and minimising the need for restraint
-
Reflect best practice to the individual
-
Respect the specific cultural needs of the patient/client
-
Where  possible  not  compromise  the  patient/clients  dignity,  privacy,  confidentiality  and
self respect

  Communication  with  the  patient/client  and  their  family/whanāu  of  all  decisions  relating  to
restraint will occur in a timely manner

  Monitoring  processes  will  be  implemented  to  evaluate  the  effect/impact  and  patient/client
response  (both  physical  and  psychological)  to  the  restraint  techniques  applied  to  ensure
that  the  identified  outcome  is  achieved  in  the  least  restrictive/intrusive  manner  without
unduly  escalating  the  situation.    Monitoring  also  requires  Clinical  Nurse  Managers  to  be
responsible  for  implementing  changes  as  a  result  of  event  reviews  and recommendations
of the Restraint Approval Group.  (See page 8).

  Any unauthorised use of restriction of a patient/client’s movement could be seen as false
imprisonment and could result in an action for assault.

MANDATORY REQUIREMENTS

  HBDHB staff will work safely within the requirements of this policy and be provided with the
appropriate level the training to assist them in this regard. Refreshers will be offered on a
regular  basis  thereafter.    A  training  register  will  be  maintained  by  the  HBDHB  Restraint
Trainer.

  Identified  staff  will  complete  the  required  HBDHB  Calming  and  Restraint  Training  and
refresher courses thereafter (e.g. Mental Health Inpatient Service, Emergency Department,
Assessment, Treatment & Rehabilitation, Intensive Care).

  A  register  of  staff  who  are  authorised  to  apply  the  approved  restraint  techniques  will  be
maintained by the HBDHB Restraint Trainer.

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

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LEGISLATIVE REGULATIONS

HBDHB must comply with the following legislation (this list is not exclusive):

  Health and Disability Services (Restraint Minimisation and Safe Practice) Standards
  NZS 8134.2: 2008
  Health and Safety In Employment Act (1992)
  Health and Safety In Employment Amendment Act (2002)
  Health and Disability Services (Safety) Act (2001)
  Protection of Personal and Property Rights Act (1998)
  Health  and  Disability  Commissioner  (Code  of  Health  &  Disability  Services  Consumers’
Rights) Regulation 1996
  Health Practitioners Competence Assurance Act (2003)
  Health Information Privacy Code (1994)
  Human Rights Act (1993)
  Privacy Act (1993)
  Mental Health (Compulsory Assessment & Treatment) Act – (1992)
  Mental Health Amendment Act (1999)
  Care of Children Act (2004)
  New Zealand Bill of Rights Act (1990)
  Crimes Act (1961)
  Criminal Procedures (Mentally Impaired Persons) Act 2003
  Intellectual Disability (Compulsory Care and Rehabilitation) Act (2003)
  Treaty of Waitangi Act (1992)

RELEVANT POLICIES

HBDHB/CPG/038 – Informed Consent Policy
HBDHB/CPG/006 – Patient Watching/1:1 Nursing/Specialling - Behaviour Observation Levels
HBDHB/IVTG/163 – Medicine – Legislation and Principles
HBDHB/IVTG/117 – Medicines – Administering and Monitoring of
HBDHB/OPM/002 – Event Management Policy
HBDHB/OPM/019 – Health and Safety Policy
HBDHB/OPM/006 – Tikanga Maori Policy
HBDHB/OPM/097 – Working Safely in the Community Policy
HBDHB/OPM/001 – Consumer Feedback Policy
HBDHB/OPM/005 – Code of Health and Disability Services Consumers’ Rights Policy
HBDHB/PPM/054 – Debriefing Policy Following a Critical Incident
MH&APPM/8501 – Seclusion Policy

MEASUREMENT CRITERIA

There is an annual audit undertaken to measure compliance with this policy.
This policy will be revised in 3 years or sooner if required.

KEYWORDS

Containment
Restraint
Technical positioning

For further information, please contact the HBDHB Restraint Co-ordinator.
This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

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PROCEDURES

Important Consideration Prior to the Application of Restraint Techniques

Use of restraint must be considered as the option of last resort, after alternative interventions
have  been  considered  and  attempted  (though  this  may  be  very  brief)  and  determined
inadequate.    Services  shall  ensure  rigorous  comprehensive  assessment  of  patient/clients  is
undertaken;  and  care  processes  reflect  the  intent  of  ensuring  patient  safety  and  wellbeing
which actively minimises the use of restraint.  The following factors should be considered prior
to the use of restraint:

  The patient/client’s physical and psychological health and intellectual capability
  The patient/client gender and culture;
  The degree of risk to the individual, others and the environment;
  The  patient/client  service delivery  plan;  which should include the  views  of  the  family, any
legal representative or identified support person
  Experience of the individual and possible compromise to the future therapeutic relationship;
  Legal status and implication

Restraint must always be used in a manner that maximises the safety of the client and others.

It must involve the use of the minimum level of force  necessary to achieve and maintain safe
control.

De-escalation  techniques  or  other  alternative  interventions  or  strategies  must  be  considered
and applied except in cases where immediate action is required to prevent serious harm.

Indications for Restraint Use

Restraint should be perceived in the wider context of risk management.  Restraint should only
be  used  in  the  context  of  ensuring,  maintaining  or  enhancing  the  safety  of  the  patient/client,
service providers or others.  Restraint may be appropriate when:

  There is a legal basis for restraint and:
-  An individual’s behaviour indicates that she/he is an imminent danger to self or others
-  An individual makes a serious attempt or act of self harm
-  An individual seriously compromises the therapeutic environment
-  An individual is making a serious or sustained attack on another person
-  It is necessary to give a planned, prescribed, essential treatment to an individual who
is resisting.
-  Where  there  is  legal  support  to  carry  out  prescribed  treatment  against  the
patient/client’s wil

When the individual is in the possession of a weapon, consideration must be given to the intent
and  capability  of  the  individual  to  use  the  weapon.    Staff  and  patient  safety  is  paramount.
Restraint  should  never  commence  if  there  is  a  risk  to  staff  safety.    In  cases  like  this,  don’t
hesitate - CALL THE POLICE.

Note:  When  restraining  a  patient  everybody  should  use  universal  precautions  relating  to
infection.

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

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Assessment

In  assessing  whether  restraint  will  be  used,  appropriate  factors  need  to  be  taken  into
consideration by a suitably skilled service provider.

  Possible alternative intervention/strategies;
  Any risks in relation to the use of restraint;
  Clinical  conditions  that  may  cause  behavioural  changes  must  be  considered  prior  to  the
use of restraint e.g. pyrexia, pain levels, dehydration, continence, etc.
  Existing advance directives the patient/client may have made;
  Past history of restraint and evaluation of episodes
  Any  history  of  trauma  or  abuse  which  may  have  involved  the  patient/client  being  held
against their will
  Maintaining culturally safe practice
  Desired  outcome  and  criteria  for  ending  restraint  (which should be  made explicit  and,  as
much as practicable, made clear to the patient/client).

In  assessing  whether  restraint  will  be  used,  the  patient/client  and/or  the  family/whanāu  are
informed and their input is sought as soon as practical.

Initiating Restraint

  Restraint is initiated only when adequate resources are assembled to ensure safe initiation
and use.  A clear plan of the roles and responsibilities of each person to be involved in the
restraint shall be made and discussed before the restraint commences;
  The  order  to  use  restraint  must  be  made  by  a  registered  health  professional,  and
documented in the patient/client’s health record.
  Each restraint episode and type of restraint requires an Event report to be completed
  Medical staff shall be informed that the restraint has been applied and the rationale for this
as soon as practicable.
  Only  techniques  of  restraint  approved  by  the  HBDHB  Restraint  Approval  Committee  may
be applied.
  Family and / or client advocate may be consulted to advocate for the client.
  Use of seclusion must not occur outside Mental Health Inpatient Services
  Where a client requires one-to-one supervision or constant observation, the requirements
of  the  HBDHB  ‘Special/Watch/1:1  Nursing  Care  for  Clients  with  Mental  Health  Diagnosis
Policy and Patient Watching Policy must be complied with.
  In an emergency situation, any person may apply approved restraints as an exception but
as soon as practicable a registered health professional takes responsibility for the decision
to continue or discontinue the restraint.

Monitoring Restraint

HBDHB Restraint  Policy and procedures inform and guide services in ensuring adequate and
appropriate  observation,  care,  dignity,  respect  and  on-going  assessment  occurs  to  minimise
the risk of physical and psychological harm to patients/clients during restraint.

The frequency and level of observation and assessment should be appropriate to the level of
risk  –  the  greater  the  risk  associated  with  the  use  of  restraint;  the  greater  the  degree  of
monitoring will be required.

The frequency and extent of monitoring of a patient/client during restraint is documented in the
patient/client health record.
This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

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They should reflect current accepted good practice and the requirements of the Standard.

Monitoring requirements need to consider all aspects of restraint use, including:

  The physical needs of the patient/client, for example, health, nutrition, hygiene, comfort and
safety.    This  includes  pressure  area  checks,  circulation  to  restrained  limbs,  colour,
breathing,  posture.    A  complete  physical  examination  must  occur  within  each  24  hour
period following physical restraint;
  The psychological needs of the patient/client, for example, support, reassurance, company,
privacy, respect and dignity, orientation to time and place, and communication;
  The  cultural  needs  of  the  patient/client,  for  example,  access  to  culturally  appropriate
support,  access  to  family/whanāu,  peers,  advocate,  legal  representative  and  respectful
removal of cultural objects.

The above observations shall be in addition to any other monitoring requirements in response
to other health conditions.

The  monitoring  process  should  also  be  used  to  evaluate  the  effect/impact  and  patient/client
response (both physical and psychological) to the restraint.

The  monitoring  process  must  include  re-evaluation  of  the  initial  indication  for  use,  desired
outcomes and duration of the restraint episode.

Communication

During  the  use  of  the  personal  restraint  continuously  communicate  with  the  patient/client,  the
team members and significant others present.
Communications with the restrained patient/client should include explaining to the individual:

  What is happening throughout the procedure:
-  Why the restraint is required, and
-  The options available for the individual in the current circumstances.

Communication with physical restraint team members should include:

  Checking the well-being of members, and
  Checking with each member that their holds are applied safely.

Communication  with  other  staff  and  significant  individuals  e.g.  patients,  visitors  directly
affected, etc., should be done by a staff member not involved in the personal include advising
them of the chosen course of action, the need for that action, and how they might assist.

Rotate designated staff to alleviate fatigue.

If restraint needs to be maintained over a prolonged period of time (longer than sixty minutes),
safe  removal  to  a  suitable  designated  area  may  be  required.  Consideration  must  be  given  to
involving family and whanāu in the management of the patient.

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

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Ending Restraint

  Ending restraint is the responsibility of a registered health professional or the person who is
trained and certified in Calming & Restraint and is facilitating the restraint process.
  Ending restraint occurs following assessment of the client and a decision that restraint is no
longer required.
  Ending restraint must be managed in a manner that ensures the safety and dignity of the
client and the safety of staff.
  However, and notwithstanding the above requirements in an emergency situation any staff
member may remove a client from their restraint.

Documentation of Restraint

All use of restraint must be reported in the Event Reporting System.  It is the responsibility of
the clinical staff directing the restraint to ensure that they complete all required documentation.

All  use  of  restraint  (personal,  physical,  or  environmental)  must  be  also  documented  in  the
patient/client health record and shall include:

  The reasons for the restraint
  The alternatives tried or attempted prior to restraint use
  The type of restraint and equipment used
  Time and duration of the restraint
  Risks associated with the use of restraint and strategies to minimise these
  The names of all staff, patient/clients and others involved in the restraint process
  A record of restraint monitoring
  Notification of family / whanāu / significant others of the need for restraint
  Evaluation of restraint use and patient/client/family/whanau response to use of restraint
  The alternatives implemented / attempted prior to restraint
  The observations made.
  Patient/client assessments, treatment provided and outcomes relating to use of restraint

Evaluating and review of restraint (at ward/unit level)

  Each  episode  of  restraint  shall  be  evaluated  in  collaboration  with  the  patient/client,  and
where  appropriate  their  family/whanāu.  This  shal   be  completed  on  the  Patient/Client
Evaluation Form (see Form 1).
  The staff involved in the restraint process are responsible for completing a Staff Debrief of
the Restraint (see Form 2).
  It is the CNM’s responsibility to ensure overall restraint use is evaluated, including:
-  Progress with reducing restraint use,
-  Adverse outcomes,
-  Staff compliance with policies and procedures,
-  Whether  an  approved  restraint  is  necessary,  safe,  of  an  appropriate  duration  and
appropriate in light of patient/client feedback and current accepted practice,
-  Whether changes to the procedure are required,
-  Whether additional training or education is needed,
-  Whether changes to existing training are required.
  It  is  the  CNM’s  responsibility  to  ensure  an  audit  of  restraint  use  is  completed  as  per  the
audit  schedule.    A  summary  report  and  action  plan  on  use  of  restraint  emerges  from  the
audit cycle.
  If the staff involved in the restraint require an additional debrief then Critical Incident Stress
Management De-briefers can be contacted via the call centre.

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

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Doc No HBDHB/CPG/080

RESTRAINT EVENT DOCUMENTATION FLOWCHART

RESTRAINT EVENT
The Clinician initiating the restraint
to complete
a RESTRAINT EVENT in the
EVENT Reporting System
Staff involved in the restraint to
complete
STAFF DEBRIEF FORM
Offer PATIENT/CLIENT
EVALUATION
(to be completed by/with the patient)
NO
YES
Document on
Complete
Patient/Client
Patient/Client
Evaluation Form &
Evaluation Form
In Health Record
Send Documentation to
QUALITY & RISK TEAM

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

Restraint - Approval and Management to Enhance Safe Restraint

Page 10 of 26
December 2015

Doc No HBDHB/CPG/080

APPROVED METHODS OF RESTRAINT

Potential Risks
Interventions to reduce
Type of
Associated Best
Potential Risk if restraint
associated with
potential risk  and
Evaluation
Restraint
Practice
method not used
restraint method
monitoring
PERSONAL

Holding Limbs
First
assess
Injury
to
Restraint  must  only  be
The
patient/client
can
Reassurance
and

patient/client  for triggers
patient/client
used as a last resort
seriously
compromise
the
explanations
to
patient/

of  agitation  and  treat

therapeutic environment
client
and
family
as

appropriately.

Limbs  of  patient/client  to  be

appropriate

held
using
approved
Behaviour  may  escalate  to

Use
alternative

techniques.
level that the service user is a
Patient/client  evaluation  to
strategies
when

(a)  Figure of Four
danger to self or others.
be  completed  after  restraint
appropriate
e.g.

(b)  Leg Holds

use
supervision  by  staff  or

The  patient/client  has  made

family members.

Above  techniques  cover  the
and  may  continue  to  make  a
Staff
debrief
to
be

3 principles to ensure that the
serious  attempt or  act  of  self-
completed  after  restraint
Offer
appropriate

limbs  are  secure  and  don’t
harm.
use
activities  or  tasks  to

cause  damage  to  joints  or

distract
from
mental
Risk  to  staff  due  to
bones.
The  patient/client  has  made
disorder.
use of inappropriate

and  may  continue  to  make  a

holds.
Limbs  of  patient/client  to  be
sustained or serious attack on
Involve
and
include
held
using
approved
another person.
family as appropriate.
techniques  to  provide  secure

and safe holds.
It  was  necessary  to  give

planned  prescribed  essential
Approach  to  restraint  needs
treatment  to  a  patient/client
to  be  coordinated  and  only
who  is  resisting  treatment
used  after  de-escalation  has
when  legal  requirements  for
failed.  All  involved  are  clear
treating
against
patients
on coordinated plan.
wishes are fulfilled.

3 Person Team
First
assess
Injury
to
patient/  Restraint to be use as a last
The  patient/client  behaviour
Reassurance
and
Full
patient/client  for triggers
client.
resort.
can
is
seriously
explanations
to
patient/
Restraint
of  agitation  and  treat

De-escalation
must
be
compromising
the
client
and
family
as

appropriately.

attempted prior to restraint.
therapeutic environment.
appropriate

This  is  a  Controlled  Document.    The  electronic  version  of  this  document  is  the  most  up-to-date and in the case of conflict the electronic version prevails over any
printed version. This document is for internal use only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

Restraint - Approval and Management to Enhance Safe Restraint

Page 11 of 26
December 2015

Doc No HBDHB/CPG/080

Potential Risks
Interventions to reduce
Type of
Associated Best
Potential Risk if restraint
associated with
potential risk  and
Evaluation
Restraint
Practice
method not used
restraint method
monitoring
3 Person Team
Use
alternative

Only  approved  restraint  holds
Behaviour  may  escalate  to
Patient/client  evaluation  to
Full
strategies
when

to be utilised
level that the patient/client is
be  completed  after  restraint
Restraint
appropriate
e.g.

a danger to self or others.
use

supervision  by  staff  or

Staff
to
attend
regular

family members.

refreshers on restraint holds to
The  patient/client  has  made
Staff
debrief
to
be

ensure  knowledge  remains
and may continue to make a
completed  after  restraint

Offer
appropriate

current.
serious  attempt  or  act  of
use

activities  or  tasks  to

self-harm.

distract
from
mental
Positional
Education
on
positional

disorder.
asphyxiation.
asphyxiation  is  provided  to  all

The  patient/client  has  made

staff, including risk factors and
and may continue to make a

Involve
and
include

prevention.
sustained  or  serious  attack

family as appropriate.

on another person.

Leg hold use to exit a room to

be  use  as  a  last  resort.    Staff
It  was  necessary  to  give

to remain on legs for the least
planned prescribed essential

possible amount of time
treatment  to  a  patient/client

who is resisting treatment

Safe  stance  and  distance  to

be  maintained  during  de-

escalation.

Staff  injury  due  to  If  staff  have  access  to  alarms

aggressive individual   these must be carried on them

at all times.

Restraint must only be used

as a last resort.

Restraint
process
to
be

coordinated  with  a  clearly

designated  person  in  the

number one role.

Staff
to
attend
regular

refreshers
and
mandatory
training days
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Doc No HBDHB/CPG/080

Potential Risks
Interventions to reduce
Type of
Associated Best
Potential Risk if restraint
associated with
potential risk  and
Evaluation
Restraint
Practice
method not used
restraint method
monitoring
3 Person Team

Full
Restraint

PHYSICAL

Mittens/Hand
Assess
patient
for  May  escalate  patient/  Safety assessment takes place  The patient/client can
Reassurance
and
Restraints
triggers  of  agitation  and  client sense of lack of  on  each  shift  which  includes  seriously compromise the
explanations
to
patient/

or confusion
control  resulting  in  mobility, cognition, potential for  therapeutic environment.
client
and
family
as
(this does not

anger
and  harm  to  others  or  self,  level  of
appropriate
include
Use
alternative  aggressiveness.
supervision required
Behaviour  may  escalate  to

handcuffs)
strategies
when

level that the patient/client is a
Patient/client  evaluation  to

appropriate
e.g.
Increased need for supervision  danger to self or others.
be  completed  after  restraint

supervision  by  staff  or
would  require  a  watch  to  be
use
family members.

employed
The  patient/client  has  made

Risk  of  injury  to

and  may  continue  to  make  a
Staff
debrief
to
be

Offer
appropriate
patient/client
15-30 minute checks
serious  attempt or  act  of  self-
completed  after  restraint

activities  or  tasks  to

harm.
use

distract from behaviour.
Reassurance and explanations

to  patient  and  family  as

Involve
and
include
required
The  patient/client  has  made

family as appropriate.

and  may  continue  to  make  a

Minimum of 2hrly checks which  sustained or serious attack on

To minimise or eliminate
includes
another person.

harm to self or others.
-  Removal  of  mittens  and

further  assessment  of  their  It  was  necessary  to  give

need at this time
planned  prescribed  essential

-  Assessment  of  redness  on  treatment  to  a  patient/client

pressure areas
who is resisting treatment

-  Offering  food  and  fluids  as

appropriate

-  Mouth and eye cares

-  Toileting

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printed version. This document is for internal use only and may not be relied upon by third parties for any purpose whatsoever.
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Page 13 of 26
December 2015

Doc No HBDHB/CPG/080

Potential Risks
Interventions to reduce
Type of
Associated Best
Potential Risk if restraint
associated with
potential risk  and
Evaluation
Restraint
Practice
method not used
restraint method
monitoring
ENVIRONMENTAL

Seclusion
To reduce:
Inability
to
leave  Staff  to  enter  as  much  as  Violent
behaviour
(or
the
Reassurance
and
Mental Health

room of own accord
possible  at  a  minimum  of  2-
immediate
threat
of
it),
explanations
to
patient/
Inpatient Unit
Violent  behaviour  (or

hour intervals.
imminent
or
unacceptable
client
and
family
as
Only
the  immediate  threat  of

level  of  risk  to  others  or  injury
appropriate

it),
imminent
or
Risk
of  injury  to
Inform  patient/client  of  risk  of  to  self  during  the  course  of  a

unacceptable  level  of
patient/client
by
injury  and  approximate  time  mental  illness  that  cannot  be
Patient/client  evaluation  to

risk to others or injury to
hitting  and  kicking  of
staff will return.
controlled
with
alternative
be  completed  after  restraint

self during the course of
door and walls.

nursing  approaches  (psycho-
use

a  mental  illness  that

social-cultural  techniques)  and

cannot  be
controlled

or
appropriate
chemical
Staff
debrief
to
be

with  alternative  nursing
Inability  to  call  for  Staff to advise patient that they  restraint.
completed  after  restraint

approaches
(psycho-
assistance
for  will  regularly  check  at  interval
use

social-cultural
seclusion bedroom
of no longer than 10 minutes.
Increased
disturbance
of

techniques)
and
or

behaviour  as  a  result  of

appropriate
chemical

Audio  monitoring  of  seclusion  marked  agitation,  hyperactivity

restraint.

rooms available.
or
grossly
impaired

judgement/reality testing.

Disturbance
of
Increased
risk
of  Fluids  to  be  provided  every

behaviour  as  a  result  of
dehydration
time room entered.
Increase  in  the  disruptive

marked
agitation,

effects  of  external  stimuli  in  a

hyperactivity  or  grossly

Access  to  water  via  ensuite  patient/client  who  is  highly

impaired

can  be  provided  dependant  on  aroused  due  to  their  mental

judgement/reality

presentation
illness.

testing.

Fluid  Balance  Chart  to  be  Deterioration in mental

The disruptive effects of

maintained  if  concern  around  state  due  to  patient/client

external  stimuli  in  a

fluid intake
inability to filter external stimuli

patient/client
who
is

highly  aroused  due  to
Inappropriate
Full and timely assessment for   Violence to others

their mental illness.
increase
of  indication
of
rapid

medication use.
tranquillisation as per protocol
Escalation
of
illness
with

Deterioration in mental

subsequent physical risk

state
due
to

Rapid  Tranquillisation  protocol

patient/client  inability  to

to be followed when required.
To
prevent
violent
or
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printed version. This document is for internal use only and may not be relied upon by third parties for any purpose whatsoever.
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Page 14 of 26
December 2015

Doc No HBDHB/CPG/080

Potential Risks
Interventions to reduce
Type of
Associated Best
Potential Risk if restraint
associated with
potential risk  and
Evaluation
Restraint
Practice
method not used
restraint method
monitoring

filter external stimuli

destructive  behaviour,  using
Seclusion

Frequency of monitoring pulse,  specific
indicators
of
Mental Health
Violence to others

temperature and vital signs are  impending  disturbance  which
Inpatient Unit

determined
as
clinically  may be identified by either the
Only
Escalation of illness with

indicated.
patient/client  or  the  staff,  and
subsequent
physical

which
should
wherever
risk

Observations
of
colour,  possible  be  part  of  an  agreed

breathing, position, activity and  management plan.
Violent  or  destructive
behaviours  must  be  recorded
behaviour, using specific
every 10 minutes.
indicators  of  impending

disturbance  which  may  Risk  of  injury  to  staff  A  minimum  of  3  Calming  and
be  identified  by  either  and  patient/  client  Restraint  trained  staff  to  enter
the  patient/client  or  the  when  entering  the  seclusion  room.    Use  of
staff,  and  which  should  seclusion room
culturally
and
gender
wherever  possible  be
appropriate staff if possible.
part
of
an
agreed

management plan.

Patient/client to be asked to sit

on  the  bed  or  to  move  away

from the door.

If  restraint  required  then  only

approved holds to be utilised.

Potential
for  Patient/client to be checked for
dangerous or harmful  dangerous or harmful objects.
objects  to  be  on  the
patient/  client  placed  Sheets  and  other  items  to  be
in seclusion.
removed  from  the  seclusion  if

risk
indicated.

Seclusion

blankets  to  be  used  in  this
case.
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Doc No HBDHB/CPG/080

APPENDIX I
ENABLERS

Both enablers and restraint limit the normal freedom of movement of the patient/client.  It is not the properties of the equipment, device or furniture
that  determine  whether  or  not  it  is  an  enabler  or  restraint  but  rather  the  intent  of  the  intervention.    Where  the  intent  is  to  promote  independence,
comfort and safety, and the intervention is voluntary, this constitutes an enabler.

The use of enablers should also follow the least restrictive option to safely meet the needs of the patient/client.

HBDHB recognises that while a number of routine procedures require the patient/client to be positioned or held in a certain way, these are done  with
the person’s consent as part of the procedure and are explained prior to the procedure(refer to technical positioning definition), these are covered
under separate policies for the specific intervention.  These are not to be confused with enablers which focus on equipment, devices or furniture.

HBDHB has approved the following as enablers when used in the stated manner, any deviation outside of this could constitute the equipment, device
or furniture being used as a restraint.

Interventions to reduce potential
Assessment of
Enabler
Associated Best Practice
Evaluation
risk  and monitoring
enabler use

Bed Rails
Obtain  patient  consent  for  the  use  Reassurance
and
explanations
to  The  need  for  use  of
Explanations
to
patient/
  Patient request
of bed rails with a clear explanation  patient/client and family as required.
enablers
must
be
client
and
family
as
  Promote
of the reason for use as a means to
documented
on
the
appropriate
independence
promote
independence,  comfort  If  the  patient  presentation  changes  the  patient’s
flowchart
/

and safety
use  of  bed  rails  must  be  reviewed  as  NADP
or
appropriate
Constant  reassessment  of

these  can  have  a  high  potential  to  place  in  the  patient’s
the need for continued use
Advise the patient that the bed rails  increase  the  risk  of  injury  rather  than  heath record.

will  be  lowered  immediately  upon  reduce the risk.

Feedback from patient/client
request.

Half  hourly  checks  of  patient/client  while
Review  of  event  reports
Before  using  bed  rails  assess  the  beside rails in place which includes visual
related
to
the
specific
suitability  and  look  at  alternative  sightings
patient/client
strategies  to  meet  the  patient’s
needs.
2 hourly checks which includes:

-  Offering food and fluids
Bed  rails  are  not  to be  used  as  the  -
Toileting
first  option  for  falls  prevention,  see  -
Change of position
falls  risk  assessment  strategies  for  -
Assessment  of  skin  integrity  and
alternative options.
pressure points
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printed version. This document is for internal use only and may not be relied upon by third parties for any purpose whatsoever.
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Page 16 of 26
December 2015

Doc No HBDHB/CPG/080

Interventions to reduce potential
Assessment of
Enabler
Associated Best Practice
Evaluation
risk  and monitoring
enabler use

Bed  rails  are  not  an  approved  To be documented in health record.
restraint within this organisation and
staff  need  to  be  clear  about  their
use  as  an  enabler  and  clearly
document same.

Assess  staffing  levels  and  where
possible
appoint
someone
to
closely monitor the patient/client

Explanations
to
patient/
Table  tops  –  when  Obtain  patient  consent  for  the  use  Half  hourly  checks  of  patient/client  while  The  need  for  use  of
client
and
family
as
placed  in  front  of  the  of
table
tops
with
a
clear  table  in  place  which  includes  visual  enablers
must
be
appropriate
patient/client
explanation  of  the  reason  for  there  sightings
documented
on
the

  To provide stable
use

patient’s
flowchart
/
Feedback from patient/client
surface for objects

If  patient/client  becomes  requests  the  NADP
or
appropriate

being used
Only to be utilised for a specific task  table be removed – discontinue use.
place  in  the  patient’s
Review  of  event  reports
  At the patient/clients
and  then  removed  e.g.  remove
heath record.
related
to
the
specific
request for stability
when meal finished

patient/client
while sitting

Maximum  of  2  hourly  checks  which

Advise the patient that the table top   includes:
-

will be removed at their request

Offering food and fluids

-  Toileting  and  walking  (if  able,  or
Before using table tops  assess the
resting in bed if sitting in chair
suitability –
-  Assessment  of  skin  integrity  and

pressure points
Assess  staffing  levels  and  where
possible
appoint
someone
to
closely monitor the patient/client

Document use in health record.

Explanations
to
patient/
Belts
–  lap  belts,  Obtain  patient  consent  for  the  use  Half  hourly  checks  of  patient/client  while  The  need  for  use  of
client
and
family
as
walking belts, etc
of  the  belt  with  a  clear  explanation  table  in  place  which  includes  visual  enablers
must
be
appropriate
  To provide safety for  of the reason for there use
sightings
documented
on
the

patient/clients when

patient’s
flowchart
/
Feedback from patient/client
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December 2015

Doc No HBDHB/CPG/080

Interventions to reduce potential
Assessment of
Enabler
Associated Best Practice
Evaluation
risk  and monitoring
enabler use
standing or sitting in
Advise  the  patient  that  the  belt  will  If patient/client becomes requests the belt  NADP
or
appropriate

wheelchairs
be removed at their request
be  removed  –  discontinue  use,  with  a  place  in  the  patient’s
Review  of  event  reports

clear  explanation  of  risks  without  the  belt  heath record.
related
to
the
specific

Before  using  a  belt    assess  the  in place.
.
patient/client
suitability for use

Maximum  of  2  hourly  checks  which
Assess  staffing  levels  and  where  includes:
there is a need appoint someone to  -
Offering food and fluids
closely monitor the patient/client
-  Assessment  of  skin  integrity  and

pressure points
Document use in health record.

This  is  a  Controlled  Document.    The  electronic  version  of  this  document  is  the  most  up-to-date and in the case of conflict the electronic version prevails over any
printed version. This document is for internal use only and may not be relied upon by third parties for any purpose whatsoever.
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Page 18 of 26
December 2015

Doc No HBDHB/CPG/080

APPENDIX II
DEFINITIONS

Abuse
Physical Abuse

Infliction of physical pain, injury of force.

Psychological /emotional Abuse
Behaviour including verbal abuse which causes mental anguish, stress and
fear

Sexual Abuse
Sexually abusive and exploitative behaviours involving threats, force or the
inability of the person to give consent

Chemical Restraint
The  use  of  medication,  solely  to  ensure  compliance  or  to  render  the
patient/client incapable of resisting

Advance
A written or oral directive:
Directive
a.
By  which  a  patient/client  makes  a  choice  about  a  possible  future
health procedure; and
b.
That is intended to be effective only when not competent.

Cultural
HBDHB  recognises  the  specific  cultural  needs  of  Maori.    Consideration
Guidelines
should  be  given  to  cultural  requirements  whilst  restraining  Tangata
Whaiora (refer to HBDHB Tikanga Best Practice Policy and Guidelines).

Cultural Safety
Practices  which  ensure  that  those  receiving  the  service  feel  that  their
culture is respected

Culture
Culture  includes,  but  is  not  limited  to,  age  or  generation;  gender;  sexual
orientation; occupation and socio-economic status; ethnic origin or migrant
experience; religious belief; and disability.

Debrief – Staff
Following each episode of restraint staff involved in the restraint complete
a  staff  debrief  form  as  a  means  of  evaluating  the  use  of  restraint  and
looking at alternatives to using restraint in the future.

De-escalation
A complex  interactive process in which the highly aroused patient/client is
redirected  from  an  unsafe  course  of  action  towards  a  supported  and
calmer  emotional  state.    This  usually  occurs  through  timely,  appropriate,
and effective interventions and is achieved by service providers using skills
and practical alternatives.

Domestic
Domestic  security  is  the  practice  of  locking  external  doors  at  night  for
Security
general security and is not covered by the Standard.

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case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
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December 2015

Doc No HBDHB/CPG/080

Enablers
Equipment,  devices  or  furniture,  voluntarily  used  by  the  patient/client
following  appropriate  assessment,  that  limits  the  normal  freedom  of
movement, with the intent of promoting independence, comfort and/ safety.

NB:  Both enablers and restraint limit the normal freedom of movement of
the  patient/client.    Where  the  intent  is  to  promote  independence,  comfort
and  safety  and  the  intervention  is  voluntary,  this  constitutes  an  enabler.
The use of enablers should be the least restrictive option to safely meet the
needs of the patient/client.

Evaluation
A  formal  process  following  each  episode  of  restraint  or  a  defined  regular
Patient/Client
intervals  at  which  the  patient/client  and  where  appropriate  their
family/whanāu,  receives  support  to  discuss  their  views  on  the  restraint
episode.

Informed
As in the Code of Health and Disability Services Consumers’ Rights 1996
Consent
(the  Code),  informed  consent  is  a  process  rather  than  a  one-off  event,
involving  effective  communication,  full  information,  and  freely  given,
competent  consent  (Rights  5,  6  and  7  respectively).    A  signature  on  a
consent  form  is  not,  of  itself,  conclusive  evidence  that  informed  consent
has been obtained.

Locked Units
In a locked unit the locked exit is a permanent aspect of service delivery to
meet  the  safety  needs  of  patient/client’s  who  have  been  assessed  as
needing that level of containment.

Although  by  definition  the  locking  of  exits  constitutes  environmental
restraint the requirements of the Standard are not intended to apply to the
locking of exits in ‘locked units’, where the unit:


Is clearly designated a ‘locked unit’;

Has  clear  service  entry  criteria  against  which  patient/client’s  are
assessed prior to entry;

Can ensure that patient/client’s using the service continue to meet the
service criteria following entry; and

Can  ensure  any  patient/client  that  does  not  meet  the  service  criteria
has means to independently exit the unit at any time.

In the absence of any of the above points, the locking of exit doors should
be treated as environment restraint

Patient/Client
A person who uses/receives a health or disability service.

Recovery
Recovery  is  a  term  used  in  Mental  Health  that  is  defined  as  the  ability  to
live well in the presence or absences of one’s mental il ness (or whatever
people  choose  to  name  their  experience).    ‘Blueprint  for  Mental  Health
Services  in  New  Zealand:  How  things  need  to  be’  (Mental  Health
Commission)

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case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
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December 2015

Doc No HBDHB/CPG/080

Restraint
The  use  of  any  intervention  by  a  service  provider  that  limits  the
patient/client’s normal freedom of movement.  (For interventions that limit a
patient/client’s freedom of movement voluntarily see definition of enabler)

Personal Restraint
Where  a  service  provider  uses  their  own  body  to  intentionally  limit  the
movement  of  a  patient/client.    For  example:  where  a  patient/client  is  held
by the service provider.

Physical Restraint
Where  a  service  provider  uses  equipment,  devices  or  furniture  that  limits
the  patient/client’s  normal  freedom  of  movement.    For  example:  where  a
patient/client is unable to independently get out of a chair due to the design
of the chair, or the position of a table or fixed tray.

Environmental
Where  the  service  user  intentionally  restricts  a  patient/client’s  normal
access to their environment.  For example: where a patient/client’s normal
access  means  of  independent  mobility  (such  as  a  wheelchair)  denied,  or
access to their environment is intentionally restricted by locking devices on
doors (this includes seclusion in the Mental Health & Addiction Service).

Restraint
The  Restraint  Approval  Committee  (HBDHB)  reviews  the  use  of  and
Approval
monitors  restraint  quarterly  and  reports  information  to  Executive
Committee
Leadership Team.

The  Restraint  Approval  Committee  reviews  and  approves  all  proposed
changes  to  restraint  use/type  across  the  DHB  and  this  includes  systems
and processes.

The  Restraint  Approval  Committee  shall  review  any  staff  or  patient/client
concerns related to the misuse of restraint.

The  Restraint  Approval Committee shall review the use of restraint  based
on data and audits obtained from the Quality and Risk Service.

Restraint
A  restraint  episode  refers  to  a  single  restraint  event  regardless  of  how
Episode
many times the patient/client has previously been restrained.

Review
A  formal  process  of  updating  and  amending  or  re-planning  based  on
evaluation of outcomes.

Technical
Technical  positioning  may  be  part  of  usual  clinical procedures or  possible
Positioning
clinical  intervention  e.g.  plaster  casts,  IV  splints,  paediatric  limb  splints,
positioning  and  support  during  procedures,  or  to  briefly  manage  clinical
symptoms.

Technical  positioning,  safe  holding  and  supporting  of  a  patient/client  so
that  a  procedure  can  be  carried  out  in  a  safe  and  controlled  manner  with
their consent, is not considered a form of restraint.

Technical  positioning  and  safe  holding,  when  the  patient/client  is  not
This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
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December 2015

Doc No HBDHB/CPG/080

competent/fully  conscious  short-term,  i.e.  emerging  from  general
anaesthetic is acceptable when used for the immediate patient/client safety
and therapeutic purposes and is within acceptable clinical practice.  Under
these circumstances, this is not considered restraint, as this is an expected
post-anaesthetic recovery room nursing intervention.

Seclusion
Where a proposed patient or patient, under the Mental Health (Compulsory
Assessment  and Treatment) Act 1992, is placed alone in a room or  area,
at any time and for any duration, from which they cannot exit freely.

Please refer to the Mental Health & Addiction Services Seclusion Policy.

Whänau/Family
The  family  or  extended  family/group  of  people  who  are  important  to  the
person who is receiving the service.

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
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December 2015

Doc No HBDHB/CPG/080

APPENDIX III

EDUCATION AND TRAINING IN RESTRAINT

All staff will have knowledge of “The Code of Health and Disability Service’s Consumers Rights
1996”, including assisting patients to access the information.

All  staff  shall have knowledge of scopes of practice,  relevant legislation and  HBDHB relevant
policies  and  procedures  including  knowledge  of  the  Tikanga  Best  Practice  Guidelines  and
other cultural considerations.

Practice and training in use of restraint should ensure that any techniques are firmly grounded
in the context of good clinical practice (refer appropriate clinical training manuals).

All employees using restraint must be trained and have completed the appropriate courses and
be  deemed  to  be  certified  as  competent  in  restraint  techniques;  and  specific  trainings  as
appropriate  to  service  area.  These  resources  shall  be  approved  by  the  HBDHB  Restraint
Approval Committee.

It is the responsibility of the Learning & Development/ Clinical Nurse Manager (CNM) to ensure
that individual records of restraint training and education are held for all staff.

Training and competency is seen as critical, both to the appropriate and safe use of restraint,
and to minimize the use of restraint.

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

Restraint - Approval and Management to Enhance Safe Restraint
Page 23 of 26
December 2015

Doc No HBDHB/CPG/080

APPENDIX IV

RESTRAINT APPROVAL COMMITTEE

The Restraint Approval Committee is responsible for:

  Approval  of  restraint  techniques  including  new  restraint  techniques  and  determining  the
education and staff training required for type of restraint

  Considering and implementing any recommendations made regarding restraint evaluation

  Auditing and reporting the education and training being undertaken to ensure standards are
met

  Maintaining a register of restraint episodes and evaluations

  Trend analysis

  Providing feedback to individuals and units.

Evaluating and Review of Restraint by the Restraint Approval Committee

  The HBDHB Restraint Approval Committee reviews the use and monitoring of restraint at
least  quarterly  and  reports  on  this  through  the  Clinical  Board  to  the Executive Leadership
Group.

  The Restraint Approval Committee shall review any staff or client concerns relating to the
use or misuse of restraint.

  The Restraint Approval Committee shall review the use of restraint based on data obtained
from  the  Quality  and  Risk  Service  and  the  MH&AS  Restraint  Co-ordinator.  This  shall
include but not be limited to:

-
Extent of restraint use and trends
-
Reviewing progress towards a restraint free environment
-
Staff compliance with policies and procedures
-
Whether  additional  training  or  education  needed  or  changes  to  existing  training  are
required.
-
Identification of opportunities for improving practice
-
Patient/client feedback
-
Any learning’s from evaluations.
-
Ongoing audits of health records in relation to restraint use and reduction

This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

Restraint - Approval and Management to Enhance Safe Restraint
Page 24 of 26
December 2015

Doc No HBDHB/CPG/080

FORM 1

Restraint - Patient/Client Evaluation

Date and Time of Event

Date and Time of Evaluation

(As soon as possible after restraint)

  Persons Involved in Evaluation:

______________________________________________________________________

______________________________________________________________________
  Tell me what was going on for you prior to the staff restraining you?

______________________________________________________________________

______________________________________________________________________
  How did you feel while the staff were restraining you?

______________________________________________________________________

______________________________________________________________________
  Did you understand what the staff talked to you about when they were restraining you?

______________________________________________________________________

______________________________________________________________________
  Were you informed of your right to support from an advocate at any time during or after
restraint?
  _____________________________________________________________________
  Were there any positive outcomes from the restraint process?

______________________________________________________________________

______________________________________________________________________
  Where do you think the restraint process needs to improve?

______________________________________________________________________

______________________________________________________________________
  Did you feel the process took into account your cultural, religious or social
needs, values and beliefs? If not; what were your concerns and how might
we improve?

______________________________________________________________________

______________________________________________________________________
  Was this Evaluation helpful?

______________________________________________________________________

______________________________________________________________________
Evaluation Facilitated by: _________________________Title_______________________
  Copy to clinical file

  Copy to Quality & Risk
This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

Restraint - Approval and Management to Enhance Safe Restraint
Page 25 of 26
December 2015

Doc No HBDHB/CPG/080

FORM 2
Restraint - Staff Debrief Form

Date and time of event

Date and time of Debrief

Debrief to be completed by: the end of shift       or within 24 hours


  Names of Staff and Job Titles Involved in Debriefing

______________________________________________________________________________

______________________________________________________________________________
  Verbal Intervention attempted (please specify de-escalation used)

______________________________________________________________________________

______________________________________________________________________________
  Describe Events Preceding Incident

______________________________________________________________________________

______________________________________________________________________________
  Staff to Discuss/Clarify Actual Incident

______________________________________________________________________________

______________________________________________________________________________
  How Was the Incident Brought to a Conclusion?

______________________________________________________________________________

______________________________________________________________________________
  Positive Aspects of Management of Incident

______________________________________________________________________________

______________________________________________________________________________
  What was the communication with family/identified support person?
   _______________________________________________________________________________
___________________________________________________________________________________
  Areas for Improvement

______________________________________________________________________________

______________________________________________________________________________
  Staff Perspectives egg: thoughts/feelings/injuries

______________________________________________________________________________

______________________________________________________________________________
  Any other Matters Arising from the Debriefing

______________________________________________________________________________

______________________________________________________________________________________

Debriefing Facilitated by ___________________________ Job Title ________________________
This is a Controlled Document.  The electronic version of this document is the most up-to-date and in the
case of conflict the electronic version prevails over any printed version.  This document is for internal use
only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board

Restraint - Approval and Management to Enhance Safe Restraint
Page 26 of 26
December 2015

Doc No HBDHB/CPG/080

FORM 3
Review of Approved Restraints

Date of
Technique:
Comments/Changes:
Reviewed By:
Signature:
Review:
Holding Limbs:
  Removing an object
HBDHB Restraint



  Figure of four
Approval Committee
  Securing arms/legs for a person lying down
Full Restraint:
  Take down to the ground
  Arm holds
  Leg holds
HBDHB Restraint



  Room exits
Approval Committee
  Rolling a person over to their stomach
  Take down to the person’s back
  Take down from a figure of four
Seclusion (MHIPS only):
  Meets  the  Ministry  of  Health,  July  2008:  Seclusion
under  the  Mental  Health  (Compulsory  Assessment
and Treatment) Act 1992
DAMHS

  Follows  the  Hawkes  Bay  District  Health  Board

Simon Shaw
Seclusion Policy
  And complies with the NZS 8134.2:2008 Health and
Disability  Services  (Restraint  Minimisation  and Safe
Practice) Standards
Mittens/Hand Restraints
HBDHB Restraint

  Hand mittens/restraints

Approval Committee
   Hand mittens/restraints attached

This  is  a  Controlled  Document.    The  electronic  version  of  this  document  is  the  most  up-to-date and in the case of conflict the electronic version prevails over any
printed version. This document is for internal use only and may not be relied upon by third parties for any purpose whatsoever.
© 2015 Hawke’s Bay District Health Board