Managing risk, minimising restraint

There are many different types of restraint, ranging from active physical interventions to failing to assist a person.

Knowing the individual, valuing the views of relatives and working as a team will help reduce the need for restraint

"Pensioner missing from care home"

For many people, the word 'restraint' makes people think of residents being tied in chairs or held down with force.

A helpful general definition of restraint is: "anything which interferes with, or stops, a resident doing what they appear to want to do

Chemical restraint This includes residents being given sedative or antipsychotic medication inappropriately, without regular review.

Technological restraint A keypad system or electronic tagging system are examples of this. For some residents, this may increase their safety, while limiting the movement of others.

Passive restraint An example of this could be when staff routinely tell a resident they should stay sitting down rather than helping them be as independent as possible.

If the resident can't give consent, it is still acceptable for restraint to be used if:

It may be that the resident, relatives and the staff team include a form of restraint into a person's care plan (for example, taking a tagging device out when walking in the neighbourhood) as a way of responding to concerns about the resident's safety.

If you do witness abusive restraint, you must report this to your line manager or a senior manager within the home as soon as possible.

"A staff member dragged a resident by the hair and tied her to a chair."

"A resident sustained bruising to his arms following restraint."

Some care staff say that they never practise restraint - that it is always wrong under any circumstances. Others say it can be vital, for the resident and themselves

Catheter bags were strapped to the leg or bed and impeded movement. Anyone who was incontinent was automatically catheterised

As these quotes from staff have shown, care practices have changed a lot over the years. A number of practices that would have been seen as reasonable and proper many years ago are now no longer acceptable.

Dennis needs help to go to the toilet, but with no help being offered from the staff member, he may become agitated and upset as he feels uncomfortable and helpless.

If care staff don't interact regularly with residents we miss important clues about their needs and situation.

Certain elements of the care environment - for example, clear signage and simple layouts - can help people better navigate their way around a care home.

It is down to weighing up the risk and whether the benefits outweigh the risks.

He was constantly thrashing about in the bed. It would have been tempting to sedate him and put up the bed rails

He was constantly thrashing about in the bed. It would have been tempting to sedate him and put up the bed rails

When my mum first came to this home, I did sign a consent form for restraining and also to allow her to have pureed foods, because she can't swallow

He was very unsettled, very angry with life.

In Des's case the care workers made a remarkable discovery about his habit of piling furniture high.

Chatting to a few of the shopkeepers, seeing the buses come and go, Nell had her routine.

She is desperate to leave and constantly pulls at the front door.

Bill becomes distressed every time after his wife has visited, usually lashing out at staff verbally and sometimes physically.

Bill becomes distressed every time after his wife has visited, usually lashing out at staff verbally and sometimes physically.

Lillian has become quite withdrawn and doesn't participate in any activities at the home.