What is inappropriate use of restrictive practices?
Inappropriate use of restrictive practices is any use of a restrictive practice that is not consistent with the requirements in the Quality of Care Principles (2014).
Under the Quality of Care Principles, restrictive practices may only be used as a last resort, when you have tried all possible alternatives and the alternatives have not worked. The process of reaching this decision must be documented.
You must notify the Commission of any incident of inappropriate use of restrictive practices that:
happens in your service
somebody has alleged happened at your service
you suspect may have happened at your service.
What is a restrictive practice?
A restrictive practice is any practice or intervention that restricts the rights or freedom of movement of an aged care consumer. There are five types of restrictive practice:
• chemical restraint
• environmental restraint
• mechanical restraint
• physical restraint
More information on the five types of restrictive practice can be found in the Commission’s Overview of restrictive practices.
What is a restrictive practice?
A restrictive practice is any practice or intervention that has the effect of restricting the rights or freedom of movement of an aged care consumer.
Inappropriate use of restrictive practices includes any use of restrictive practices that is not in line with a consumer’s documented care and services plan. Any such incident is a reportable incident, including emergency situations.
Whether the use of a restrictive practice is a reportable incident depends on the circumstances in which it is used and whether these are consistent with the requirements described in Part 4A of the Quality of Care Principles (2014). Use of restrictive practices is not a reportable incident if:
- the restrictive practice is used in the course of providing home services
- before the restrictive practice is used, the circumstances and the way it is to be used are set out in the consumer's care and services plan
- before restrictive practice is used, the details regarding the circumstances and way it is to be used are clearly documented in the consumer’s care and services plan
- the restrictive practice is used in the circumstances and way set out in the consumer’s care and services plan
- after the use of the restrictive practice, the details are documented as soon as practicable.
Refer to this SIRS Home services- Reportable incidents fact sheet for guidance on what your service needs to consider before, during, and following the use of restrictive practices.
Planning for the use of restrictive practice
It is important to carefully plan and manage the use of any restrictive practice in partnership with consumers, their representatives and health practitioners.
Before a restrictive practice is used in relation to a consumer, you must document:
- the circumstances in which restrictive practices may be used, including the consumer’s behaviours that may require the use of restrictive practice
- details regarding the way restrictive practice is to be used, including:
- the type of restrictive practice and how to safely apply it
- the duration of use
- the expected frequency
- the intended outcomes of using the restrictive practice.
It is also good practice to:
- document any alternative strategies that may be used
- document the consumer’s informed consent in the consumer’s care and services plan
- schedule regular reviews to reassess the need for restrictive practice.
Care and services plans
Where restrictive practices are used, they must be in accordance with the consumer’s documented care and services plan.
As required by Standard 2 of the Quality Standards, care and services plans must:
- consider the risks to the consumer's health and well-being to inform the delivery of safe and effective care and services
- address the consumer's current needs, goals, and preferences
- be developed in collaboration with the consumer and others involved in the consumer’s care
- be readily available to the consumer
- be regularly reviewed for effectiveness and when circumstances change or incidents impact on the needs, goals or preferences of the consumer.
As part of an effective care and services plan, it is good practice to include a behaviour support plan for consumers who require behaviour support.
Inappropriate use of restrictive practice by a family member
The inappropriate use of restrictive practices by a consumer’s family member (for example, locking the consumer in a room or overmedicating a consumer) is not a reportable incident as it is not connected to the provision of care and services to the consumer.
However, where workers witness or suspect a consumer is being subjected to inappropriate use of restrictive practices, this must be escalated and responded to accordingly (per requirements to identify and respond to abuse and neglect of consumers under Quality Standard 8).
This may include, for example, engaging with the consumer’s representative, holding discussions with others involved in the consumer’s care (such as their GP), referring the consumer to an advocacy service, or considering reassessment of the consumer’s care and services.
There may be warning signs that a consumer has been subjected to the inappropriate use of restrictive practices. These include:
- red marks, bruising, tears or grazing on the skin that appear to be associated with a physical restraint
- tiredness, drowsiness or confusion
- an increase in frustration, anger, complaints
- refusal to take medication or fearfulness of medication.
You should always investigate or escalate to the appropriate person within your service when there are changes in a consumer’s behaviour or where these warning signs are shown.
Remember, if you suspect that a reportable incident has happened, you must notify the Commission. You should not wait for definitive proof.
Responding to inappropriate use of restrictive practice
If there is evidence, an allegation, or suspicion of a consumer being subjected to the inappropriate use of restrictive practices, you must immediately ensure their wellbeing. This may include arranging medical or psychological assistance. All details of the incident must be recorded in your IMS.
If the incident may be unlawful, such as a physical assault, or if there is any ongoing danger to any person, you should also contact the police.
While managing the incident, you must practice open disclosure by communicating your provider’s remedial actions to the consumer and their family or representatives.
Reporting inappropriate use of restrictive practices
Inappropriate use of restrictive practices, like any reportable incident, must be recorded in your IMS and the Commission must be notified.
If there were reasonable grounds to contact the police, or if there was an injury that needed medical or psychological treatment to resolve, it is a Priority 1 reportable incident, and you must notify the Commission within 24 hours of becoming aware.
If there were no reasonable grounds to contact the police and no injury that needed medical or psychological treatment to resolve, it is a Priority 2 reportable incident. In that case, you must notify the Commission within 30 days of becoming aware.
A quality incident notification requires more than simply transcribing the details from progress notes about the incident or copying text from your IMS. It is important that the person making the notification is familiar with:
- what happened
- when the incident happened
- where the incident happened
- who was involved, including the affected consumer, workers involved in the incident, and other affected people
- what actions were taken after the incident
- what caused the incident (if known)
- what changes will be made as a result of the incident (if known).
If you become aware of further information after submitting an initial notification, you must update the Commission.
When you provide clear and comprehensive information early on, it is less likely that the Commission will need to:
- ask for further details
- require you to conduct an investigation
- directly investigate the matter itself.