Development and implementation of an individualized primary plan, intervention, or treatment plan is the most important tool for maintaining safety. The need for restraint, then, can be viewed as a break down in the primary plan. When the primary plan breaks down and assault occurs, restraint may become the safest decision, but only as a last resort. In these instances, restraint is an indicator of treatment failure.
Guidelines for restraint include specific principles, some of which are listed below. Each requires careful assessment and critical thinking prior to, during, and following application.
Focus on outcomes
Restraint is not a treatment objective and contraindicates long-term goals
Operate within Pro-ACT principles
All principles introduces in the Pro-ACT course remain applicable in restraint.
Use Crisis Communication
Never stop communicating with a client.
Make restraint your last resort
Stop and think before choosing to deprive a person of his or her liberty.
Protect breathing and circulation
Virtually every death can be attributed to a restriction of breathing and circulation and staff must ensure that continual assessment of breathing and circulation is being done.
Pain-inducing methods are punitive and abusive.
Take only reasonable risk
Restraint contains risk. Staff must assess the risk of injury from assault against the risk posed by restraint.
Restrain only as a team
Pro-ACT does not teach single person restraint.
Look at what you are doing
Continual assessment asks the question, “Is the restraint still necessary?”
Remember: The safest restraint is no restraint.