Quality Statement 8: Mechanical Restraint - Health Quality Ontario (HQO)

Resources Quality Statements Advisory Committee About

8

Mechanical Restraint

People living with dementia are not mechanically restrained to manage agitation or aggression.

Background

Mechanical restraints are associated with serious injury and increased mortality, and do not provide any clinical benefit for the management of agitation or aggression in people living with dementia. Through the proper management of behavioural symptoms, it is possible to avoid the use of mechanical restraints. Hospitals and long-term care homes should move toward zero use of mechanical restraints.

What This Quality Statement Means

For Patients

You should not be physically restrained.

For Clinicians

Avoid the use of mechanical restraints for managing agitation or aggression in people living with dementia. Always use alternative strategies.

For Health Services

Ensure that hospitals and long-term care homes have systems, processes, and resources in place to support health care providers in achieving zero use of mechanical restraints for managing agitation or aggression in people living with dementia. Examples include appropriate staffing and access to health care professionals with specialized training.

Quality Indicators

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression who are placed in mechanical restraints for agitation or aggression

Denominator: total number of people living with dementia and symptoms of agitation or aggression
Numerator: number of people in the denominator who are placed in mechanical restraints for symptoms of agitation or aggression
Data sources: local data collection; proxy measures could be calculated based on data currently collected for restraint use in acute mental health care (Ontario Mental Health Reporting System, provided by the Canadian Institute for Health Information) and for daily physical restraints in long-term care (Continuing Care Reporting System, provided by the Canadian Institute for Health Information)

Definitions Used Within This Quality Statement

Mechanical restraints

These are devices that restrict people’s freedom of movement in emergency situations and are attached to, adjacent to, or worn by people involuntarily when they pose an imminent risk of harm to themselves or others. Mechanical restraints are different from safety restraints—such as bed rails, geri-chairs, or mitts—that are used in nonemergency situations to enhance people’s safety, mobility, or quality of life. The intent of the device use determines whether it is a mechanical restraint or a safety device.

Evidence to Improve Care