Restraints

A restraint limits a person’s movement, access, or ability to leave. It may be a physical device, a restrictive environment, or a medication used primarily to control behaviour rather than treat an underlying condition. The label on the intervention does not decide the issue; its purpose, effect, and the applicable provincial and organisational definition do. The clinical threshold is deliberately high. Restraint may be used only when all of the following are true: 1. It is necessary to prevent serious bodily harm to the patient or another person. 2. Less-restrictive alternatives have been attempted and have failed. 3. The intervention provides greater freedom or quality of life than the available alternatives. 4. A documented treatment plan authorising the restraint has been obtained, with consent from the patient or substitute decision-maker unless an emergency exception applies. This is not a test of whether the patient is difficult, confused, or inconvenient to care for. A patient who repeatedly tries to remove an intravenous line may need assessment and protection, but that behaviour alone does not establish the restraint threshold. The clinician must...