Restraints and seclusion

by Kashmala Siddique
Restraining client
• A form of control
• Restraint, or self-control, a personal virtue
• Medical restraint, form of general physical restraint used for medical
purposes
• Physical restraint, the practice of rendering people helpless or keeping
them in captivity by means such as handcuffs, ropes, straps, etc.
Seclusion
• Seclusion is the act of secluding (i.e. isolating from society), the state
of being secluded, or a place that facilitates it (a secluded place). A
person, couple, or larger group may go to a secluded place for privacy
 or peace and quiet. Seclusion of a single person is also called solitude
.
Restrictions on the seclusion of a man and a woman

• In some cases where there are legal, religious or social restrictions on

two people having physical intimacy, there may be restrictions on
being together in a secluded place. For example, under traditional
schools of sharia or Islamic law, a man and a woman who are not
married and not mahram, being together in a house, a bathroom, or a
secluded place, may be forbidden. A man and woman could be in a
secluded area for work purposes, just talking, or anything that does
not allow them to pass their limits. See also yichud—a similar rule in
Judaism.
Implication of restraints
• Physicians should be familiar with any relevant legislation governing
the use of restraints in their jurisdiction.
• The Act does not apply in psychiatric facilities where the Mental
Health Act governs the use of restraints. The Restraint Minimization
Act does not affect the ability to restrain or confine an incapable
individual who requires immediate action to prevent serious bodily
harm when no substitute decision-maker is available.
Standards for use of restraints
• The cases also indicate that physicians should follow current
standards of care and institutional policies when giving medication,
including appropriate monitoring and follow-up.
Risk management considerations

• Attempt to de-escalate the situation using other methods.

• Obtain an adequate history, including medications and co-morbidities.
• Conduct an appropriate physical examination.
• Explain the plan for the use of restraints calmly and clearly to patients or
substitute decision-makers.
• Document the rationale for using restraints and use the least restrictive means
necessary.
• Ensure clear and readily available policies and procedures for monitoring
restrained patients and ensure appropriate training of staff.
• Adhere to applicable regulations, laws, and accreditation standards.
Managing medical-legal risk

• Experts who examined the care in these cases noted the need for
effective communication and documentation. It is essential that
physicians speak with patients or families, clearly explaining why and
how restraints are being employed. Those discussions and the
information relied on to make the clinical decision in favour of
restraints should be documented.
• Inadequate staff or monitoring was particularly significant in the CMPA
restraint cases where the outcome was patient death. These cases call
attention to the need for adequate resources and equipment to
effectively monitor and safely secure restrained patients.
Restraints
Seclusion