use of restraint

[everdrew89]

Does anyone have any experience of the use of restraint being authorised under a DoLS? I understand there are different levels of restraint and that in my husband's case the lowest level has been applied for and authorised - it's called 'handholding' apparently but I've spoken to three different professionals and each have given me a different explanation of what that means ... I can't find easy information online so have just emailed the DoLS team to ask but thought I'd ask on here too to see if anyone has experience of this ...

Thanks ...

 

[TNJJ]

Hi.It will be in his care plan.It will say what it is and when it is to be used.Sometimes it can be used for personal care to stop him hitting out.Or it can be if someone is getting aggressive.It all depends on the circumstances.

 

[jaymor]

When my husband became bed bound and could no longer weight bear I bought him a specialist chair and he was allowed to sit out for two hours a day. His wore a seat strap to stop him tipping forward out of the chair when it was in an upright position. The chair could be wheeled about so he was able to go into the garden or any public room within the nursing home. He had a DOLS.

I’d never seen any other form of restraining someone even though it was a challenging behaviour unit.

 

[TNJJ]

I forgot to put the technical term that is used.Restrictive Practice.Used as a last resort and it has to be used as in the care plan.Or Care Profile as it is sometimes called.

 

[mildredgreen]

I have recently found that amazon sell all kind of restraints to the public. This has got to be dangerous. Even in care homes I have never seen them used. I have started a petition to try and stop them selling such things.

 

[LadyA]

When my husband lost the ability to walk or move unaided, but still had enough strength to push himself out of his chair in an effort to stand and walk, the Nursing Home asked me about using a restraining seat belt. He'd already fallen several times (no injuries, thankfully), and as it was a constant thing, i.e. he would attempt to stand innumerable times in an hour, it was the safest thing. However, any form of "restraint" is very frowned on here, and had it been discovered that he was strapped in during an inspection, they would have had to remove the seat belt. And leave him to fall. The staff did take him for a walk about every two hours. For that, they had to have two members of staff (and one had to be a physiotherapist), literally holding him up. But they did that for him, because he had always been obsessed with walking around the Home. I was more than happy with how they handled the situation.

 

[Grannie G]

My mother was a corridor walker in her care home . I tried to visit at different times so I wouldn`t be expected. [ I`d recommend this to anyone who has someone in residential care if they have any doubts about the home]

On one visit she was strapped into her chair with something like a back seat car seatbelt. I would have been ok with it because she had fallen a couple of times, but the guilt on the face of a young carer as soon as she saw me, plus the fact she ran for help rather than approach me caused alarm bells to ring.

 

[mildredgreen]

The Journal of Medical Ethics, publicised the negative consequences of restraints which include:

Bruises
Decubitus ulcers
Respiratory complications
Urinary incontinence and constipation
Poor nutrition
Increased dependence in activities of daily living
Impaired muscle strength and balance
Decreased cardiovascular endurance
Increased agitation
Increased risk for mortality caused by strangulation or as a consequence of serious injuries—for example, fracture, head trauma

In addition to those physical consequences, restraints are frequently ineffective and don't prevent falls. Rather, research has shown that injuries are escalated because of the force the person needed to use to escape from the restraint.

 

[Palerider]

The Journal of Medical Ethics, publicised the negative consequences of restraints which include:

Bruises
Decubitus ulcers
Respiratory complications
Urinary incontinence and constipation
Poor nutrition
Increased dependence in activities of daily living
Impaired muscle strength and balance
Decreased cardiovascular endurance
Increased agitation
Increased risk for mortality caused by strangulation or as a consequence of serious injuries—for example, fracture, head trauma

In addition to those physical consequences, restraints are frequently ineffective and don't prevent falls. Rather, research has shown that injuries are escalated because of the force the person needed to use to escape from the restraint.

That is very accurate Mildregreen. The best form of restraint is no restraint for the person concerned and the carers. If it does need to be used it should be with the minimum force necessary and for the shortest time and carried out by people trained in its use.

 

[Jaded'n'faded]

I would think these things are used for the convenience of staff. A strapped-in person doesn't need to be checked as often.

If there were adequate staff to watch patients, restraints wouldn't be needed. But there aren't.

 

[mildredgreen]

My daughter works with clients that other care homes wont accept. Some have come there from Prison and can be very violent. She has never seen restraints used. They cause more harm than good!

 

[Palerider]

I would think these things are used for the convenience of staff. A strapped-in person doesn't need to be checked as often.

If there were adequate staff to watch patients, restraints wouldn't be needed. But there aren't.

This is one of the reasons why the MHA was revised, but more importantly people have died from unecessary restraint. I have seen this myself where a carer has thought that strapping someone into a chair is acceptable, only for them to stand up fall and the chair create further harm as they fall and become entangled with the chair.

I can't see a good reason to restrain unless the person needs an intervention in their best interests, and even then it should only be while that intervention is carried out.

 

[mildredgreen]

My daughter works with clients that other care homes wont accept. Some have come there from Prison and can be very violent. She has never seen restraints used. They cause more harm than good!

 

[Palerider]

My daughter works with clients that other care homes wont accept. Some have come there from Prison and can be very violent. She has never seen restraints used. They cause more harm than good!

I used to do agency work in the lock-up wards in Liverpool to earn extra cash as a student, I had never seen any of these potentially violent men restrained.

What is more upsetting is that the previous scenario I described went to the coroners, I can discuss it because it is now in the public domain. That person died with 24 hours of admission and so the coroner called a hearing to determine death. I felt for the carer concerned. If it had been a local safegaurding we could have managed it differently, but unfortunately it wasn't in the end. The carer genuinely thought what she had done was the right thing to do, with no guidance in the CH. Athough the coroner only assertains cause of death, the verdict can and often does lead to a police investigation, in this case it did. Criminal negligence is not something anyone would want to face as a carer, especially when they had innocently thought strapping someone into a chair was the right thing to do.

 

[Jaded'n'faded]

This is one of the reasons why the MHA was revised, but more importantly people have died from unecessary restraint. I have seen this myself where a carer has thought that strapping someone into a chair is acceptable, only for them to stand up fall and the chair create further harm as they fall and become entangled with the chair.

I can't see a good reason to restrain unless the person needs an intervention in their best interests, and even then it should only be while that intervention is carried out.

I can't think of any justifiable reason either.

I find it worrying that some care homes even have these awful devices available. Surely any such action would necessitate approval from the DoLS team and can't just be used 'as the CH manager sees fit'?

And whilst it might be 'easier' for staff, I still think it is completely unacceptable unless it has been fully discussed and agreed by medics, family, etc.

 

[AliceA]

I have recently found that amazon sell all kind of restraints to the public. This has got to be dangerous. Even in care homes I have never seen them used. I have started a petition to try and stop them selling such things.

I have signed one.

 

[Palerider]

I can't think of any justifiable reason either.

I find it worrying that some care homes even have these awful devices available. Surely any such action would necessitate approval from the DoLS team and can't just be used 'as the CH manager sees fit'?

And whilst it might be 'easier' for staff, I still think it is completely unacceptable unless it has been fully discussed and agreed by medics, family, etc.

There is no justification for restraint other than interventions based on best interests. Someone may wander up and down all day long, but that is not a need to restrain them. Someone may be at risk of falls, but that is a part and parcel of the condition they have, it is not an indication for restraint...etc etc etc