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Restraint as a Last Resort

To Prevent Falls and Fall Injuries

​​​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.

When people are at risk of falling the goal is to prevent falls and fall injuries. At the same time it’s important to help them be as independent as they can be. The best way to do this is to find and remove the reasons for falls. Common reasons include medicine side effects, vision problems, and muscle weakness from not being active enough. Use the Falls Risk Self-Assessment Checklist to find out more.

Falling can lead to injury but using restraint also has many risks.

Use of restraint can cause:

  • loss of muscle strength and ability to walk alone (deconditioning)
  • loss of independence like not being able to get to the bathroom without help
  • feelings of being upset and embarrassed
  • trouble sleeping because of not being active enough
  • bruising or skin breakdown
  • a serious or life-threatening injury (climbing over bed rails and falling, getting stuck between rails, sliding down in a chair with a lap belt and not being able to breathe)
  • other serious medical issues such as heart stress, slower blood circulation, infection and delirium (a sudden increase in confusion that can be life-threatening)

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

  • Review all prescriptions, supplements and over the counter medicines. Stop any unnecessary medicines and use the lowest dose possible for all others. Being on 3 or more medicines makes it more likely a person will fall.
  • Wear glasses. It’s important to have an up-to-date prescription. Consider a separate pair of reading glasses instead of bi or tri-focal lenses.
  • Improve lighting and reduce clutter.
  • Walk often, with help, until stronger.
  • Wear non-slip shoes, socks or slippers.
  • Use aides such as a cane, 2 or 4 wheeled walker, or walker with a seat.
  • Get involved in group therapy and social activities during the day.
  • Make sure the bed is in the lowest position, or place the mattress on the floor.

Helpful conversations for staff, family, and care partners

  • Special things to know to help with walking and exercise.
  • How to release a temporary restraint to help the person walk or change position.
  • Challenges such as back pain, mobility or strength that make it difficult to help.
  • Services, help and supports that are available in the community.

Current as of: May 1, 2018

Author: Seniors Health Strategic Clinical Network, Alberta Health Services