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DH launches new controls on patient restraint


New guidance to stop the “outdated” and potentially “dangerous” use of physical restraint on care patients have been launched by the Department of Health.

It means health staff will be urged to avoid the controversial use of deliberate face-down restraint, a method used to pin patients to the ground and physically prevent them from moving.

There are concerns it can result in dangerous compression of the chest and airways and put the patient at risk, the DH said.

Care minister Norman Lamb said the new guidance will stop the inappropriate use of all restrictive interventions, including seclusion and chemical restraint.

Norman Lamb

Norman Lamb

It follows a government investigation into the 2011 Winterbourne View Hospital scandal, where staff were found to be using restraint as a way to abuse patients.

A similar study by the charity Mind also found that restrictive interventions were being used for too long, often not as a last resort and even to inflict pain, humiliation or to punish patients.

Mr Lamb said: “No one should ever come to harm in the health or care system. Although it is sometimes necessary to use restraint to stop someone hurting themselves or others, the safety of patients must always come first.

“This new guidance will stop inappropriate use of all types of restraint, reduce this outdated practice and help staff to keep patients safe.”

The guidance has been led by the Royal College of Nursing and developed jointly by health and care professionals and patients.

“Nurses have been at the forefront of developing the new approach”

Peter Carter

Dr Peter Carter, chief executive and general secretary of the RCN, said: “Nobody wants to see a repetition of the horrific events of Winterbourne View.

“Nurses have been at the forefront of developing the new approach, which is the result of committed co-operation between professionals, and which makes use of the views of those who have experienced physical intervention.

“This moment is a major step forward in making difficult situations more manageable, and it is at the heart of compassionate care.

“The government’s resolve in bringing about this change is to be applauded and the RCN will be working with them to make this approach a reality for all vulnerable people.”

The DH is providing £1.2m for staff training in the new guidelines, which are called Positive and Proactive Care.

The guidance says there might be a rare occasion when staff need to restrain people, such as stopping someone from harming themselves, but that it must be used only as a last resort and for the shortest time possible.

“Physical restraint can be humiliating, dangerous and even life-threatening”

Paul Farmer

Paul Farmer, chief executive of Mind, said the guidance marks a “significant step” towards changing attitudes to restraint.

“We know that healthcare staff do a challenging job and sometimes need to make difficult decisions very quickly,” he said.

“This is comprehensive guidance that looks to address the system as a whole, transforming cultures and attitudes so that difficult situations are less likely to arise and so that staff are supported to use alternatives to restraint when faced with challenging behaviour,” he added.

“When someone is in a mental health crisis they need help, not harm. Physical restraint can be humiliating, dangerous and even life-threatening and our own research indicates that some trusts are currently using it too quickly.”





Readers' comments (6)

  • David Dickinson

    Let us remember the frailty of human memory and our potential as a species for distorting truth. For those who can recall, prior to the advent of "Control & Restraint" the common sight of rugby scrums occurring on the day room floor with any available arm or leg being grabbed whilst cleaners calmly continued about their business was in many areas a common sight. For the caring staff who desperately longed for an effective alternative that avoided the kind of injuries common to both residents and staff but moreover the sheer the sheer regular mayhem and its effects upon fellow residents, the advent of "C&R" was little short of a revelation. I remember my first course at Rampton Hospital in 1988 conducted by senior instructor Bill Simpson. The recurring theme was patient safety and the absolute necessity of remaining vigilant with constant observation of the patients condition, minimizing pressure and maintaining airways during the procedures. Considerable time was spent exampling and placing each student into the experience of the patient. From what I understand and having read some of the subsequent accounts of the episodes that resulted in the later appalling injuries and deaths, these crucial considerations were completely absent. Winterbourne was about sheer thuggery with the service user pinned under a chair upon which sat the "carer" additionally pinning her with his foot on the palm of her outstretched hand whilst calmly conversing with her in a scene straight out of a Camus novel. The demise of C&R was due paradoxically to its very effectiveness ..applied inevitably with ignorance and similar thuggery with the inevitable results. What we do not wish to see again however are the equally bizarre rugby scrums. However, matters have somewhat improved thanks to the the arrival and continuing promotion of the positive practice and differential reinforcement procedures initiated within the Centre for Applied Behaviour Analysis by some Los Angeles hippies in the 1980s posing as clinical psychologists.

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  • David Dickinson

    QUIZ: Was it Cheech and Chong or Lavigna and Willis?

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  • @ David Dickinson | 4-Apr-2014 3:12 pm

    must be Dr. Gary W. LaVigna and Dr. Thomas J. Willis; the first two researched almost exclusively chemical restraint.

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  • all staff also need adequate training in suitable alternative protective measures for the safety of all concerned as well as all those in proximity to an violent or aggressive patient.

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  • David Dickinson

    Its very easy to go round in circles..the absurdity of human existence and reality. Firstly..apologies to Sr Restraint instructor Mr Simpson of Rampton Hospital circa was of course Graham, not Bill.

    So where do we go from here? The box in the photo was a time-out cubicle that greeted the new team on walking into our new Behavioural Unit in 1983 and designed by the Sr Clinical Psychologist. Managers refused to throw it out despite us telling them that no one was going to be locked into that thing, so we did it..taking it apart and throwing it in the skip. We were nearly fired. Similar managers today would of course declare the box inhumane and point to prevalent opinion. Some don't only go with the flow but condemn everything with simplistic statements that suggests easy solutions to age old problems. The purpose of face down restraint was NOT to enable carers to relax whilst the patient gently asphyxiated. It was a precursor to standing and walking off under safe control, hopefully in a relaxed manner and away from the location where the initiating problem had occurred and with no additional control pressure being required because the aggressive 200lb 6' patient provoked by an issue beyond the means of simple social negotiation had opted to desist fighting because three ordinary female carers controlled his worst efforts with complete anxiety free professionalism. The other function of face down restraint was to communicate with the aggressor calmly whilst preventing them from focusing and escalating aggression towards arbitrarily targeted individuals and of course spitting which is not uncommon. The restraint coordinator would communicate calmly in their ear, establishing rapport and gently persuading the individual to desist whilst providing a breathing space for pulses to settle and for rage to disperse. Therefore, it was for a limited duration and had a clear purpose. It was not to give staff an extended break whilst using the patient as a convenient cushion. Standing someone from a laying back position is risking a kick and, with their head uncontrolled the means of visually targeting and delivering a bite or spit or the means to assess and consider a further aggressive action. Watch any marshal art and the only means of stopping a kick or punch is to "block" it which risks injury to both patient and carer and is therefore not an option and would be a clear abuse. Rising from a face down position enables the aggressors head to remain safely lowered until a quick assessment by the coordinator enables a signal to the other two carers that he or she is about to negotiate with the subject an imminent release contingent upon the continued desisting from injury risking behaviours.. Such releasing with a continuing calm aftermath is the objective. The objective is NOT to indulge the restraint skills of staff or to demonstrate who is dominant. What is perhaps of more concern is what happens next? Is it the seclusion room, intramuscular tranquilizer or both? The purpose of competent compassionate restraint has to be the quick effective return to aggression-free ordinariness perhaps ending better than it started. The mark of really great restraint competence is to conclude with laughter. After all, life's a gas, just hope its gonna last.

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  • Other patients, clients need protection, as well as staff from violent patients and sometimes relatives. Hard to maintain appropriate controls without some degree of humiliation

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