Please review the following information and complete the short quiz at the end.

Carewest is committed to a “Least Restraint” approach, which preserves and promotes the individual’s dignity, comfort, and autonomy through individualized approaches to care. When a client’s responsive behaviour continues to put the client or others at risk of harm, a restraint may be considered. 

 Before using least restrictive physical, mechanical, pharmacological, or environmental restraints, all appropriate supportive approaches are considered to enable clients to function safely.
The care team discusses with and obtains approval for restraints from the attending physician, director of program, client service manager (CSM), and the client/family/legal decision maker.
The health record and care plan must include the method and frequency for monitoring the client’s comfort, safety and response to use of the restraint. Care staff must also document that monitoring was completed as restraints are considered high risk.
A secure space is a secure unit, a secure site, or technological measure, such as a wander guard system that limits the client’s ability to leave the unit or site.
Ongoing use of any restraint or secure space is reviewed by the team and client/legal representative at a minimum during the annual conference.
A Restraint is any measure that is environmental, pharmacological, mechanical, or physical that is used to protect a client from self-harm or prevent harm to others.

A Physical Restraint is any manual method, including holding a client, to allow care to be performed.

Mechanical Restraint includes items such as bed-side rails, seat belts that cannot be released by the client, chairs with locking table tops, such as Broda chairs, or positioning devices where the effect is restraint and client mobility is prevented.

An Environmental Restraint is any device or barrier that restricts a client’s movement within a room or space. 

At Carewest, all bed side rails are down as the standard and all lower spilt side rails (except on Rehab and Recovery units) must be secured to prevent unplanned use. Bed Rails should primarily be used where there is an assessed need for mobility and positioning.  Staff use the Bed Rails Checklist to guide decision making on the appropriate and safe use of bed rails. 

In the absence of an approved reason, medications such as antipsychotics or benzodiazepines may be considered a form of Pharmacological Restraint.  When a client’s responsive behaviour continues to be a serious danger to self or others, medications may be considered. The team must first try all supportive and least restrictive approaches. The team discusses the risks, benefits and treatment goals with the client/family/legal representative. In Continuing Care Programs, the Behaviour and Symptom Mapping Tools (BSMT) are used by the team to monitor client response to antipsychotic medications.

When are Restraints reviewed?

•             At least annually at care conferences.

•             When the client’s health status changes.

•             When the client or legal representative wants to cancel consent.

Who do I contact for more information?

Manager, Clinical Standards and Nursing Practice, or the Therapy Support Coordinator

You have completed the overview.  One on the units, you should also be familiar with the policies (located in the Care and Service manual ) and familiarize yourself with related forms (e.g., Restraints tracking, Managed Risk Agreement)

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* 1. First name (as it appears on your application)

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* 2. Last Name (as it appears on your application)

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* 3. Carewest site

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* 4. Unit

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* 5. Physical restraint is any

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* 6. Mechanical restraints include

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* 7. A bed side rail may be put up

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* 8. Pharmacological restraint (antipsychotic medication) may be considered when

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* 9. As a rule, all bed side rails are down and all lower split rails secured to prevent unplanned/unapproved use.

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* 10. When are Secure Spaces reviewed?

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* 11. When a client has a restraint in place, staff must document that the monitoring checks written on the care plan were completed.

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* 12. What approved form is used to monitor and document client response to antipsychotic medication?

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* 13. Where can you find Carewest’s policies on Least Restraint?

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* 14. When a restraint is used, the method and frequency of client monitoring is included on

Thank you for completing the quiz. You will be required to complete any question you skipped before submitting.  If you score less than 80%, you need to redo the quiz to pass. 
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