Inappropriate use of restrictive practices | Aged Care Quality and Safety Commission

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
•   seclusion.

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.

Some examples of restrictive practices include:

use of bed rails or a lowered bed that makes it difficult for a consumer to get out
seclusion or confinement of a consumer where voluntary exit is prevented or not facilitated
use of a bed belt or lap sash restraint
physically blocking a consumer’s path, holding onto a consumer to prevent their movement or holding a consumer down
removing the battery out of a consumer’s electric wheelchair or putting mobility aids out of a consumer’s reach to limit their movement.
any drugs used to control, sedate, or restrict movement instead of for the treatment of a diagnosed health condition.

Any use of restrictive practice that is not consistent with the Quality of Care Principles constitutes inappropriate use of restrictive practice and is a reportable incident.

Some examples of restrictive practices include:

use of bed rails or a lowered bed that makes it difficult for a consumer to get out
placing equipment in front of a consumer to limit movement
seclusion or confinement of a consumer where voluntary exit is prevented or not facilitated
use of a bed belt or lap sash restraint
physically blocking a consumer’s path, holding onto a consumer to prevent their movement, or holding a consumer down
removing the battery out of a consumer’s electric wheelchair or putting mobility aids out of a consumer’s reach to limit their movement.
putting mobility aids out of a consumer's reach to limit their movement
any drugs used to control, sedate, or restrict movement instead of for the treatment of a diagnosed health condition.

Inappropriate use of restrictive practice does not include:

use of restrictive practice that is consistent with the Quality of Care Principles
use of restrictive practices without consent in an emergency, where the consumer’s substitute decision-maker is informed as soon as possible from the time of applying the restrictive practice
where a provider administers a drug to a consumer as prescribed for the treatment of a diagnosed health condition and this is documented.

Inappropriate use of restrictive practice does not include:

where a provider uses the restrictive practice in line with the consumer’s documented care and services plan, uses the restrictive practice in the course of providing aged care in a home or community setting, and records the use of the restrictive practice as soon as possible following the use.

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 be:

developed in collaboration with the consumer and others involved in the consumer’s care
readily available to the consumer
regularly reviewed for effectiveness and when circumstances change or incidents impact on the needs, goals or preferences of the consumer.

A care and services plan must include a behaviour support plan for a consumer who has restrictive practices considered, applied, or used as part of their care. More information can be found in this Commission fact sheet.

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.

Warning signs

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.

Your service must notify the Commission as soon as possible upon becoming aware of any significant new information about a reportable incident after making a notification.

Tip

It is easier to make a good quality notification to the Commission if you have the information you need at hand.

Educating workers to report incidents correctly within your IMS will make it easier to notify the Commission when a reportable incident happens.

Work tools

The fact sheet, Reportable incidents: inappropriate use if restrictive practices, provides more detailed guidance for reporting of incidents in a residential service relating to this incident type.

The example Inappropriate use of restrictive practice shows the level of detail the Commission expects when receiving a notification about this incident type.

You can use the Practical tips guide to ensure your notification contains all of the required information.

Work tools

The fact sheet, Reportable incidents: inappropriate use of restrictive practices, provides more detailed guidance for reporting of incidents in a home or community setting relating to this type of reportable incident.

Contact us

If you have a question about the SIRS, you can call us on 1800 081 549.

This phone line is open 9 am to 5 pm (AEST) Monday to Friday and 8 am to 6 pm (AEST) Saturday to Sunday.

You can also email us at sirs@agedcarequality.gov.au.

Facilitated Workshops

The Commission provides facilitated workshops to sector participants. All current workshops are available on the Commission’s Workshop page.

Online Learning

The Commission’s Aged Care Learning Information Solution, Alis provides free online education for employees of Commonwealth-funded aged care providers, including a module covering Inappropriate use of restrictive practices.

You can access Alis at learning.agedcarequality.gov.au.

Disclaimer

The information contained on this page is intended to provide you with general guidance; however, it is your responsibility to be aware of your legislative requirements.