RNAO releases new guideline on the use of restraints
The Registered Nurses’ Association of Ontario (RNAO) has released a new practice guideline, “Promoting Safety: Alternative Approaches to the Use of Restraints.” This document contains 12 recommendations, including eight specific actions for nurses.
- Nurses should establish a therapeutic relationship with the client who is at risk of harm to self/others to help prevent the use of restraints.
- Nurses should assess the client on admission and on an ongoing basis to identify any risk factors that may result in the use of restraints.
- Nurses should utilize clinical judgment and validated assessment tools to assess clients at risk for restraint use.
- Nurses in partnership with the interprofessional team and client/family/substitute decision-makers (SDM) should create an individualized plan of care that focuses on alternative approaches to the use of restraints.
- Nurses in partnership with the interprofessional team should continuously monitor and re-evaluate the client’s plan of care based on observation and/or concerns expressed by the client and/or family/SDM.
- Nurses in partnership with the interprofessional team should implement multicomponent strategies to prevent the use of restraints for clients identified at risk.
- Nurses in partnership with the interprofessional team should implement de-escalation and crisis management techniques and mobilize the appropriate resources to promote safety and mitigate risk of harm for all in the presence of escalating responsive behaviours.
- Nurses in partnership with the interprofessional team should engage in care practices that minimize any risk to the client’s safety and well-being throughout the duration of any restraining process.
The guideline also recommends that education on working with clients at risk for the use of restraints should be included in all entry to practice nursing curricula as well as ongoing professional development opportunities. In addition, it is recommended that healthcare organizations should implement risk management and quality improvement strategies to enable a culture that promotes alternative approaches to the use of restraints in support of client rights and staff safety. As well, the organization’s model of care should promote an interprofessional team approach in collaboration with the client/family/SDM that supports the use of alternative approaches and prevents the use of restraints.
The document notes that nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation.
To access the RNAO guideline, visit www.rnao.org.