Quality Indicators in Residential Aged Care Services (RACS) Use of Physical Restraint Indicator

What are the Victorian Residential Aged Care Quality Indicators all about ? The online resource:  Enhances knowledge of residential aged care QIs  Explains how to use them as part of your improvement toolbox 2 Why?  Helps residential aged care facilities monitor and focus on areas of high risk to residents  Improves resident quality of care and quality of life

1. The What: What do we want to achieve by monitoring physical restraint? Know the proportion of the use of physical restraint with your residents, and the trends and scope of the issue so you can take action to:  Increase understanding about physical restraint and its implications  Implement strategies for preventing the use of physical restraint Recommended reference ranges Physical restraint per 1,000 occupied bed days Quality Indicators in RACS Resource: Use of Physical Restraint3 MeasuresLower target rate Upper limit rate Intent to restrain 00 Physical restraint devices 00

2. The Why: Why is monitoring use of physical restraint important? Quality Indicators in RACS Resource: Use of Physical Restraint4 Restraint is an aversive practice, device or action that interferes with a resident’s ability to make a decision, or which restricts their free movement. Evidence suggests that physical restraint is used for between 12-49% residents in residential aged care (Alzheimer’s Australia, 2014) Physical restraint can cause negative physical and psychological outcomes. Family members or legal representatives do not have the legal right to request that a resident be restrained. Evidence indicates that restraint does not prevent falls or falls-related injuries and is likely to exacerbate behaviours. A restraint-free environment is the recommended standard of care. Adverse events or harm associated with use of physical restraint include:  death and pain  decreased cognitive function  Infection and pressure injury development  falls

3. The How: How to collect and report this indicator How many/how often? Two measures for use of physical restraint :  1. Intent to restrain (important to look at all ways in which this could occur: definitions A, B and C)  2. Use of physical restraint devices commonly associated with physical restraint (definition B) Three audits on each of three audit days every Quarter Total of nine observation audits of each resident per quarter Quality Indicators in RACS Resource: Use of Physical Restraint5 How do you collect and report the data? Audits are observational, and should be unannounced Use restraint definitions A, B and C for measure 1; and definition B for measure 2 Record on data recording sheet with comments Exclude: secure areas and perimeter alarms Include respite residents

4. Definitions are important! Three definitions are used for this indicator: Definition A Intent to restrain: ‘ intentional restriction of a residents’ voluntary movement or behaviour by the use of a device, or removal of mobility aids, or physical force.’ (Source: Department of Health and Ageing 2012, Decision making tool: responding to issues of restraint in aged care, Commonwealth Government of Australia, Canberra.) Physical restraints include but are not limited to: lap belts, table tops, posey restraints or similar products, bed rails, and chairs that are difficult to get out of, such as bean bags, water chairs and deep chairs. Definition B Presence of Physical restraint devices:  Bedrails  Chairs with locked tables  Seatbelts other than those used in active transport  Shackles and manacles  Safety vests Definition C: Definitions A and B do not list all possible physical restraints. The audit process should consider whether placement of furniture, use of concave mattresses, lap rugs with ties, intentionally locking a bedroom door or any other devices are in use with the intention to restrict free movement. These should be included in Measure 1. See the QIs Resource Materials for more detail – and supporting evidence! Quality Indicators in RACS Resource: Use of Physical Restraint6

3. The How: How to collect and report this indicator Quality Indicators in RACS Resource: Use of Physical Restraint7 Quick tips for data accurate data use of restraint data collection  Use actual observation to collect data, not documentation  Even if the restraint is temporary, it must still be counted  Any use of physical restraint should be investigated at the time of audit  Note where residents, families or advocates have requested physical restraint

Quality Indicators in RACS Resource: Use of Physical Restraint8

1.True or False: Physical restraint can cause death  True  False 2. Residents to be excluded from the physical restraint indicator data collection are: A.Respite residents B.Residents receiving end of life care C.Residents who were admitted to the facility with a history of absconding D.None of the above Quality Indicators in RACS Resource: Use of physical restraint9 Quiz

3. True or False: The Physical restraint indicator can be collected using incident reports  True  False 4. Physical restraint data will be more accurate if: A.The data is collected by direct observation B.The audits are unannounced C.A and B D.A only Quality Indicators in RACS Resource: Use of physical restraint10 Quiz

5. True or False: Physical restraint is used for up to half the residents in residential aged care  True  False 6. Which of the following statements is incorrect? A.A resident’s family can legally request the use of restraint to prevent a fall B.The target for the rate of physical restraint in Victorian RACS is 0 C.Careful use of restraint has been found to prevent falls D.All of these statements are false Quality Indicators in RACS Resource: Use of physical restraint11 Quiz

How did you go? Quality Indicators in RACS Resource: Use of physical restraint12 Quiz

Using Quality Indicators to make a positive difference to resident care Quality Indicators in RACS Resource: Use of physical restraint19 End of Use of Physical Restraint Indicator

Quality Indicators in RACS Resource: Use of physical restraint14 To receive this publication in an accessible format Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services, December, 2015 Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. ISBN (Online) Available at quality/workforce-training-development/online-training