New legislation introduced to minimise the use of restraints
Amendments have been made to the Quality of Care Principles 2014 to minimise the use of chemical and physical restraints in residential care settings, and to include specific requirements of aged care providers in relation to their use.
Under the amended Principles, a restraint is defined as “any practice, device or action that interferes with a consumer’s ability to make a decision or restricts a consumer’s free movement.”
Where physical or chemical restraints are used, approved providers must meet a number of conditions.
Physical restraint must not be used unless:
- the consumer has been assessed by an approved health practitioner with day-to-day knowledge of the consumer as posing a risk of harm to themselves or others; and as requiring restraint;
- alternatives to restraint have been used for the consumer to the extent possible;
- the restraint is the least restrictive form of restraint possible; and
- the provider has the informed consent of the consumer (or their representative) to the use of restraint, unless the restraint is necessary in an emergency.
Chemical restraint must not be used unless:
- a medical practitioner or nurse practitioner has assessed the consumer as requiring the restraint and has prescribed the medication for the purposes of restraint;
- the decision to use restraint is documented in the consumer’s care and services plan; and
- the consumer’s representative is informed of the use of the chemical restraint.
If restraint is used, the Amending Principles, require providers to regularly monitor the consumer and record information in the consumer’s care and services plan.
Minimising use of chemical restraints
Self-assessment tool on minimising the use of chemical restraints
The Commission wrote to all residential aged care providers in June 2019 with a Self-Assessment Tool for Recording Consumers Receiving Psychotropic Medications to support their process of continuous improvement in relation to the standard of care and services. This form of assessment contact was used specifically to assist services to identify where chemical restraint is used and take action to use alternative strategies to minimise its use. Services are not required to submit this self-assessment tool to the Commission.
The tool provides details of the type of information record that the Commission will seek to review when undertaking assessment of aged care services against the Standards, and as part of that, monitor how services are effectively overseeing the use of restraints. When undertaking a site visit, assessment teams will seek to understand how a service is monitoring consumers who are receiving psychotropic medication(s), in particular anti-psychotics and benzodiazepines, including for PRN (as needed) use.
During site visits, the Commission’s Assessment Teams will also seek evidence of the actions taken by providers to use alternative strategies to minimise the use of restraints at their service, consistent with best practice clinical care and regulatory requirements.
Download: self-assessment tool (available as word document).
Understanding and applying best practice
Existing guidance on best practice is set out in the 'Decision Making Tool: Supporting a Restraint-Free Environment’ (Decision Making Tool). The Decision Making Tool notes the use of restraint should always be the last resort and viewed as a temporary solution to any behaviour causing concern. Additionally, its use should only be considered after exhausting all reasonable alternative options and be informed by a comprehensive assessment of a consumer and their interactions
Assessment of compliance with the new requirements
The Commission will seek evidence of actions taken by residential aged care services to use alternative strategies and to minimise the use of chemical and physical restraints consistent with the Aged Care Quality Standards and the 2019 Principles.
Providers are encouraged to self-assess compliance with the Principles on minimising the use of restraints, and to identify and review the management of consumers who are currently chemically or physically restrained. You can find more details on the principles here. The Guidance and Resources for providers to support the Quality Standards has also been updated to reflect the new legislation and include helpful resources for providers.
Details of these updates can be viewed on the Updates Log.
Frequently Asked Questions
Click on the boxes below to reveal responses to our FAQs on the use of restraints.