Which of the following criteria must be present for a device to be a physical restraint?

Q: What devices is likely to be a physical restraint?

A physical restraint is any device that restricts a patients movement and cannot be removed easily by the patient. Examples of restraints include vest or wrist restraints, geriatric chairs with tables, and bed side rails.

Q: What is the key factor that defines a physical restraint?

Physical restraint was defined as any action or procedure that prevents a persons free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a persons body that he/she cannot control or remove easily.” [22].

Restrictive interventions involve the use of bodily restraint (physical and mechanical restraint) and seclusion.

Table of Contents Show

Urgent physical restraint
Use of restrictive interventions
Urgent physical restraint
What is considered a physical restraint?
What devices is likely to be a physical restraint?
What is the key factor that defines a physical restraint?
Which items would the nurse identify as an example of a physical restraint?

The regulation of restrictive interventions applies to all people receiving mental health services in a designated mental health service regardless of the person’s legal status under the Mental Health Act 2014 or age.

The Victorian Government is committed to reduce and wherever possible eliminate the use of restrictive interventions.

The use of a restrictive intervention on a person receiving mental health services in a designated mental health service must beauthorised by:

An authorised psychiatrist or delegate must be notified as soon as practicable if the restrictive intervention is authorised by a registered medical practitioner or the senior registered nurse on duty.

The authorised psychiatrist or delegate must then examine the person as soon as practicable to decide whether continued use of the restrictive intervention is necessary.

If the authorised psychiatrist or delegate is not available to examine the person, he or she must arrange for a registered medical practitioner to examine the person to decide whether continued use of the restrictive intervention is necessary.

Urgent physical restraint

The use of urgent physical restraint on a person receiving mental health services in a designated mental health service may be approvedby a registered nurse.

The registered nurse may only approve urgent physical restraint if:

it is necessary as a matter of urgency to prevent imminent and serious harm to the person or another person
an authorised psychiatrist or delegate, a registered medical practitioner or the senior registered nurse on duty is not immediately available to authorise the use of bodily restraint on the person.

Use of restrictive interventions

A restrictive intervention may only be used on a person receiving mental health services in a designated mental health service after all reasonable and less restrictive options have been tried or considered and have been found to be unsuitable.

A restrictive intervention may only be used where it is necessary to prevent serious and imminent harm to the person or another person.

Bodily restraint may also be used where necessary to administer treatment or medical treatment.

The senior registered nurse on duty, a registered medical practitioner or an authorised psychiatrist or delegate must immediately release the person from the restrictive intervention as soon as the grounds for the use of the restrictive intervention no longer apply.

Urgent physical restraint

The use of urgent physical restraint without authorisation must be for the minimum time necessary to:

prevent imminent and serious harm to the person or to another person; and
seek the authorisation of an authorised psychiatrist or delegate, a registered medical practitioner or the senior registered nurse on duty for the use of bodily restraint on the person.

An authorised psychiatrist or delegate must take reasonable steps to ensure that, as soon as practicable after commencement of the use of a restrictive intervention on a person, the following persons (as applicable) are notified of its use, the type of restrictive intervention and the reasons for using it:

the nominated person
a guardian
a parent if the person is under the age of 16 years
a carer, if the use of the restrictive intervention will directly affect the carer and the care relationship
the Secretary, Department of Human Services or delegate if the person is the subject of a custody to the Secretary order or a guardianship of the Secretary order (eg. Manager, Child Protection).

Safeguards

High levels of clinical care, monitoring and reporting are required when restrictive interventions are used. The authorised psychiatrist has increased responsibilities for oversight of authorisation and continued use of restrictive interventions.

The person who authorises the use of a restrictive intervention must ensure that the person’s needs are met and the person’s dignity is protected by the provision of appropriate facilities and supplies, including bedding and clothing appropriate to the circumstances, food and drink and adequate hygiene and toilet arrangements.

A person being bodily restrained (including urgent physical restraint) must be under continuous observation by a registered nurse or registered medical practitioner.

A registered nurse or registered medical practitioner must:

clinically review the use of bodily restraint (including urgent physical restraint) on a person as often as is appropriate, having regard to the person’s condition, but not less frequently than every 15 minutes
clinically observe a person in seclusion as often as is appropriate, having regard to the person’s condition, but not less frequently than every 15 minutes.

An authorised psychiatrist or delegate must examine a person in seclusion or being bodily restrained as frequently as the authorised psychiatrist is satisfied is appropriate in the circumstances to do so, but not less frequently than every four hours.

If it is not practicable for an authorised psychiatrist or delegate to conduct an examination at the frequency that the authorised psychiatrist or delegate is satisfied is appropriate, the person must be examined by the registered medical practitioner when so directed by the authorised psychiatrist, but not less frequently than every four hours.

The authorised psychiatrist must provide a written report to the Chief Psychiatrist about the use of restrictive interventions in the designated mental health service. The report will be generated through the CMI/ODS.

What is considered a physical restraint?

Examples of physical restraint devices include: lap belts, bed rails, Posey restraints or similar, chairs with tables attached, and chairs or mattresses that are difficult to get out of such as tip-back chairs, water chairs, bean bags and curved edge mattresses.

What devices is likely to be a physical restraint?

A physical restraint is any device that restricts a patient's movement and cannot be removed easily by the patient. Examples of restraints include vest or wrist restraints, geriatric chairs with tables, and bed side rails.

What is the key factor that defines a physical restraint?

Physical restraint was defined as “any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person's body that he/she cannot control or remove easily.” [22].

Which items would the nurse identify as an example of a physical restraint?

For example, a vest restraint to prevent a patient fall is an example of a physical restraint and a sedating medication to control disruptive behavior is considered a chemical restraint. Both restrict the person's ability to move about freely.