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Restraint as a Last Resort

In a Behavioural Emergency

​​We all want safe, compassionate care for those we care about, and those we care for. Sometimes safety requires limiting a person’s activity or behaviour. Restraining a person is a last resort in an emergency or when other things haven’t worked. Many healthcare providers, including Alberta Health Services (AHS) have a Restraint as a Last Resort policy. There are 4 types of restraint:

  • Physical – holding or moving the person to another location
  • Medicines – like lorazepam or haloperidol
  • Mechanical – bed rails, hand or foot restraints
  • Environmental – the patient’s own room, quiet room, seclusion room

Patients and their care partners can give ideas to lower or avoid the use of restraint. If the use of restraint is likely to continue, the patient or guardian needs to consent to this care plan, unless it becomes an emergency such as a physical safety risk.

The goals during a behavioural emergency are to:

  • keep the person safe while helping them keep their dignity
  • help the person regain composure and return to their daily routine

The goals after a behavioural emergency are to:

  • explore how the situation could have been handled differently to have a better outcome
  • help the person develop skills to manage their emotions themselves
  • lower or avoid the need to use of restraint in the future

What can be done to use restraint as a last resort?

  • Reassure and welcome: You’ve come to the right place, I’m glad you’re here.
  • Listen to their concerns, even if the words don’t make sense.
  • Keep questions simple and in a calm tone - they may not be able to hear you properly or focus on what you’re saying. Give them time to answer.
  • Recognize that their perception is their reality, and it may be very frightening for them: ‘That must be scary’ instead of ‘That’s not real’. Don’t argue.
  • Be present, be genuine, and develop rapport. Try to limit the number of care givers to reduce confusion and to prevent the person having to repeat their experience several times.
  • Discuss needs and wants. Provide quiet time, meaningful activities, music and medicine as needed. Offer limited choices to give the person some sense of control.
  • Don’t isolate them – check in often to see if they’re okay, offer food and water.
  • Allow dignity: let them wear their own clothes, cover self-injury wounds, and help them to the bathroom regularly.

Helpful questions to ask

  • Is there someone you’d like to be with you?
  • What are some things that upset you?
  • What are some things that help you feel safe?
  • Has this happened before? What helped?
  • How can I help you to feel safe while we talk about what’s happened?

Helpful conversations for staff, family, and care partners

  • How are you feeling? Are you dealing with other challenges other than this situation? Who is supporting you?
  • Are you willing or available to help support this person emotionally right now?
  • Has this happened before? What helped?
  • What upsets the person? What are some early signs to recognize when they’re getting upset?
  • What helps them feel calm and relaxed?

Things to know before going home

  • Recovery takes time and isn’t always a smooth transition.
  • Are there any follow-up appointments? With whom and when?
  • Has the person been offered medicine or prescriptions? Would they prefer for a family member or care partner to be responsible for their medicine? What are the instructions for the medicines?
  • Are there any services, help and supports available in the community such as self-care, peer support groups, family doctor, and counsellor?
  • Have others who need to know been informed of them going home (home care, or if returning to a group home, long term care, supportive living facility, or lodge)?
  • Do you have a safety plan for the person and the family or care partner?

Current as of: May 1, 2018

Author: Addiction and Mental Health Provincial Policy Team, Alberta Health Services