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Restraint procedure at a secure dementia unit (10HDC01231)
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(10HDC01231, 23 April
Home and hospital ~ Secure dementia unit ~ Registered nurse
~ Falls ~ Restraint minimisation standards ~ Staff training ~
Communication ~ Rights 4(1), 4(2)
An 85-year-old man, resident in a secure dementia unit for two
months, fell frequently during this time and was often agitated and
aggressive. Few observations were taken during his stay, and his
care and management were not evaluated regularly.
On multiple occasions, staff used a lap-belt to restrain the
man. His wife strongly objected to the use of restraint and
communicated her wishes to staff several times. The procedure
required by national Health and Disability Services standards, and
the unit's restraint policy, was not followed. In particular, there
was no discussion with family about the use of restraint by
appropriate health professionals before restraint was initiated.
The man's agitation increased after he was restrained.
The unit was responsible for ensuring that the man received safe
and appropriate care. The fact that multiple staff used restraint
but did not follow the appropriate procedure indicates systemic
failures. By failing to comply with the relevant standards, the
unit breached Right 4(2). The unit also breached Right 4(1) for not
having appropriate documentation and incident reporting systems in
place, for failing to ensure its staff communicated effectively
with each other about the man's care (including about restraint),
and for failing to ensure its staff evaluated his progress or
responded appropriately to his falls and aggression.
The nurse manager, who was also the restraint minimisation
coordinator, was responsible for managing the unit, educating staff
in restraint minimisation, and ensuring the restraint policy was
followed. She failed to complete and evaluate the man's support
plan, or to manage and respond to his falls and aggression
appropriately. She also failed to ensure that staff received
appropriate training in restraint minimisation and failed to act
appropriately in response to her staff restraining the man.
Accordingly, she breached Right 4(1).
A second, experienced RN, was responsible for restraining the
man on at least two occasions without following the restraint
policy. Consequently, she did not provide services with reasonable
care and skill, and breached Right 4(1).