IDENTIFICACION DE PROBLEMAS Y CAUSAS IDENTIFICACION DE PROBLEMAS Y CAUSAS

All of the following requirements must be met when restraining a resident by a physical device under section 31 or section 36 of the LTCHA:

• Staff apply the physical device in accordance with any manufacturer’s instructions. • The physical device is well maintained.

• The physical device is not altered except for routine adjustments in accordance with any manufacturer’s instructions.

Section 110 (2) of the Regulation specifies the additional requirements that apply when a resident is being restrained by a physical device under section 31 of the LTCHA. All of the following requirements must be met:

• Staff may only apply the physical device that has been ordered or approved by a physician or RN(EC).

• Staff must apply the physical device in accordance with any instructions specified by the physician or RN(EC).

• The resident must be monitored while restrained at least every hour by a member of the registered nursing staff or by another member of staff authorized by a member of the registered nursing staff.

• The resident must be released from the physical device and repositioned at least once every two hours (this requirement does not apply when bed rails are being used if the resident is able to reposition himself or herself).

• The resident must be released and repositioned any other time when necessary based on the resident’s condition or circumstances.

Key Considerations

No other staff may be authorized by any of the above professionals to assess a resident who is being restrained.

All of the requirements in section 31 of the LTCHA and section 110 of the Regulation apply when restraining with a physical device. This includes a situation where a device that could be used as a PASD is being used to restrain a resident.

A resident may be restrained using a physical device only so long as there is a significant risk that the resident or another person will suffer serious bodily harm if the resident is not restrained (see section 31 (3) of the LTCHA).

Reassessment every eight hours is a minimum standard. Whether or not eight hours have passed since the last reassessment, the resident must be reassessed as soon as staff determine, based on their monitoring, that the resident’s behaviour no longer poses a significant risk and that a less restrictive physical device could be used or that the use of the physical device could be discontinued.

Key Linkages

A physical device cannot be applied under section 31 of the LTCHA to restrain a resident who is in bed, except to allow for a clinical intervention that requires the resident’s body or a part of the resident’s body to be stationary or if the physical device is a bed rail used in accordance with section 15 of the Regulation, pursuant to section 110 (6) of the Regulation.

Physical devices applied to a person’s body while in bed may have negative outcomes, including the development of contractures and pressure sores, and may result in serious injuries including death.

Before a resident is restrained while in bed in order to permit a clinical intervention, the requirements in section 31 of the LTCHA and all applicable sections of the Regulation must be met.

If a resident is restrained in any other place – for example, in a wheelchair – to provide a clinical intervention, the Home must meet the requirements in section 31 of the LTCHA and all applicable sections of the Regulation.

Section 110 (3) of the Regulation specifies the additional requirements that apply when a resident is being restrained by a physical device under the common law duty set out in section 36 of the LTCHA. All of the following requirements must be met:

• The resident must be monitored or supervised on an ongoing basis and must be released from the physical device and repositioned when necessary based on his or her condition or circumstances.

• The resident’s condition must be reassessed by a physician, an RN(EC) attending the resident or a member of the registered nursing staff at least every 15 minutes and at any other time when necessary based on the resident’s condition or circumstances. • The Home must comply with the provisions of section 31 of the LTCHA before

continuing to use a physical device to restrain a resident when immediate action is no longer necessary.

After a physical device has been used, the reason for using it must be explained to the resident or, when the resident is incapable, to the resident’s substitute decision-maker.

Key Consideration

Restraining under the common law duty enables a Home to respond quickly to high-risk situations. A resident being restrained by a physical device under these circumstances may be highly agitated and may require ongoing and heightened monitoring and reassessment.

As set out in section 110 (5) of the Regulation, the Home is required to provide appropriate post-restraining care when the resident is released from the physical device or when the use of the physical device is discontinued, in order to ensure the safety and comfort of the resident.

Key Consideration

If a person has been restrained for an extended period of time, he or she may need post-restraining care once he or she is released (e.g., a person may be at risk of falling once the restraint is removed). Post-restraining measures may include providing gait and balance training or reassurance, and assisting the resident to walk. This applies to any restraining done under either section 31 or 36 of the

LTCHA.

The Home must document every use of a physical device to restrain a resident under section 31 of the LTCHA. Documentation must include all of the following:

• The circumstances precipitating the application of the physical device. • The alternatives considered and why those alternatives were inappropriate. • The person who made the order, what device was ordered, and any instructions

relating to the order. • Consent.

• The person who applied the device and the time of application.

• All assessment, reassessment and monitoring, including the resident’s response. • Every release of the device and all repositioning.

• The removal or discontinuance of the device, including the time the device was removed or its use discontinued.

• The post-restraining care provided.

The Home must document every use of a physical device to restrain a resident under section 36 of the LTCHA (Common Law Duty). Documentation must include all of the following:

• The circumstances precipitating the application of the physical device.

• The person who made the order, what device was ordered, and any instructions relating to the order.

• The person who applied the device and the time of application.

• All assessment, reassessment and monitoring, including the resident’s response. • Every release of the device and all repositioning.

• The removal or discontinuance of the device, including the time the device was removed or its use discontinued.

• The post-restraining care provided.