DC132-Restrictive Practices and Physical Interventions Policy

Registration Number: {{org_field_registration_no}}

Restrictive Practices and Physical Interventions Policy

1. Introduction and Purpose

{{org_field_name}} is committed to delivering care that promotes dignity, independence, and respect for all service users. Restrictive practices and physical interventions are only used as a last resort, when all other options have been exhausted, and always in the best interests of the individual. This policy outlines our approach to managing restrictive practices in line with the Health and Social Care Act 2008, the Care Act 2014, the Mental Capacity Act 2005, and CQC regulations.

2. Scope of the Policy

This policy applies to all employees, agency staff, volunteers, service users, and their families. It covers home visits and community-based support.

3. Definition of Restrictive Practices

Restrictive practices refer to any intervention that limits an individual’s freedom of movement, choice, or decision-making. These practices are only implemented when all other de-escalation strategies have been exhausted and when there is an imminent risk of harm to the individual or others. The use of restrictive practices must always be proportionate, reasonable, and the least restrictive option available. It is essential that all restrictive practices are recorded, monitored, and reviewed regularly to ensure they remain appropriate and necessary.

This includes:

Physical Restraint: The use of physical force to prevent movement. This can involve holding an individual to stop them from harming themselves or others. Physical restraint should only be applied by trained staff and must be proportionate to the situation. Examples include holding someone’s arms to prevent them from hitting themselves or others. Prolonged physical restraint can lead to distress and physical harm, so it should be used for the shortest time possible.
Mechanical Restraint: Equipment used to restrict movement. This includes the use of belts, straps, or specialised seating to limit an individual’s mobility. Mechanical restraint should only be used when prescribed by a healthcare professional and outlined in the individual’s care plan. It is crucial that regular checks are carried out to ensure the individual’s comfort and safety.
Chemical Restraint: Medication used to manage behaviour rather than medical conditions. This involves the administration of sedatives, antipsychotics, or other medications to calm an individual. Chemical restraint should only be used when other methods have failed, and its use must be reviewed by a medical professional regularly. The individual’s consent or best-interest decision must be documented before administration.
Environmental Restraint: Restricting access to certain areas. This includes locking doors, using keypads, or other methods to prevent individuals from entering or leaving specific areas. Environmental restraint must not be used as a form of punishment and should be clearly documented in the individual’s care plan, with regular reviews to assess ongoing necessity.
Seclusion and Isolation: Separating an individual from others. This practice involves placing an individual in a room or area away from others, usually when their behaviour poses a risk to themselves or others. Seclusion should only be used for the shortest time possible and in line with the individual’s care plan. Continuous monitoring must be in place to ensure the individual’s safety and well-being during seclusion.

It is important to note that the use of restrictive practices must always be a last resort, applied in the least restrictive manner, and for the shortest duration necessary. Staff must ensure that any intervention is carried out with dignity, respect, and compassion, with the individual’s rights and well-being at the forefront of care delivery. All restrictive practices must be documented comprehensively, including the rationale, duration, and outcome, to support continuous monitoring and improvement.

4. Legal and Ethical Framework

Our approach aligns with the following legislation and regulations:

Mental Capacity Act 2005: Ensures decisions are made in the best interest of those lacking capacity.
Care Act 2014: Promotes well-being and prevents abuse or neglect.
CQC Regulation 13 (Safeguarding): Protects service users from improper treatment.
Equality Act 2010: Prohibits discrimination based on protected characteristics.

5. Guiding Principles

Restrictive practices are only used when:

There is an immediate risk of harm to the individual or others.
Less restrictive alternatives have been tried and failed.
The intervention is proportionate, necessary, and the least restrictive option.
It is carried out with dignity, respect, and the individual’s rights in mind.

6. Risk Assessment and Prevention

To minimise the need for restrictive practices, we adopt a proactive approach that prioritises the safety and well-being of service users while respecting their autonomy and rights. This approach includes:

Conducting Thorough Risk Assessments: Each service user undergoes a comprehensive risk assessment upon admission and regularly thereafter. This assessment identifies potential triggers, behaviours of concern, and associated risks. The assessment also considers the individual’s physical and mental health, communication needs, and environmental factors. Risk assessments are reviewed and updated following any significant incident or change in circumstances.
Developing Personalised Care Plans: Based on the risk assessment, a personalised care plan is created for each service user. This plan outlines individual preferences, strengths, needs, and specific strategies for preventing distress and challenging behaviours. The care plan includes clear guidelines for staff on de-escalation techniques and the conditions under which restrictive practices may be considered as a last resort. Care plans are co-produced with the individual, their family, and relevant professionals to ensure they reflect the person’s values and choices.
Training Staff in Positive Behaviour Support and Non-Restrictive Approaches: All staff receive training in Positive Behaviour Support (PBS), equipping them with the skills to identify early signs of distress and intervene proactively. This training emphasises non-restrictive approaches, such as verbal de-escalation, redirection, and offering choices. Staff are also trained to understand the psychological and emotional impact of restrictive practices, ensuring that interventions are compassionate, proportionate, and respectful.
Promoting a Positive Environment: Creating a supportive and person-centred environment is key to preventing challenging behaviours. This includes ensuring service users have access to meaningful activities, social interactions, and support networks. Staff are encouraged to build trusting relationships with service users, fostering open communication and understanding.
Regular Monitoring and Review: Risk assessments and care plans are subject to regular review, ensuring they remain relevant and effective. Any use of restrictive practices prompts an immediate review, including feedback from the service user and involved parties, to identify lessons learned and improve future practice.

7. Consent and Best Interest Decision-Making

Consent and best interest decision-making are central to the ethical use of restrictive practices. Our approach ensures that interventions respect the individual’s rights, preferences, and dignity:

Obtaining Informed Consent: Consent must be obtained before any intervention, except in emergency situations where immediate action is required to prevent harm. Informed consent involves explaining the nature, purpose, and potential risks of the intervention, ensuring the individual understands and agrees without coercion. Staff must document the consent process thoroughly.
Assessing Capacity: If an individual lacks capacity to consent, decisions must follow the Mental Capacity Act’s best interest framework. This involves a thorough capacity assessment, considering the individual’s ability to understand, retain, and weigh relevant information and communicate their decision. Capacity assessments are decision-specific and time-sensitive, recognising that capacity can fluctuate.
Following the Best Interest Framework: When an individual lacks capacity, any decision regarding restrictive practices must be made in their best interest. This process involves considering the individual’s past and present wishes, beliefs, and values. The least restrictive option must always be prioritised, and the decision must be proportionate to the identified risk.
Involving Key Stakeholders: Family members, advocates, and relevant professionals should be involved in the decision-making process to ensure a holistic approach. This includes consulting healthcare providers, social workers, and independent mental capacity advocates (IMCAs) where appropriate. Their input helps ensure decisions are balanced, fair, and centred on the individual’s well-being.
Documentation and Review: All decisions regarding consent and best interest must be clearly documented, including the rationale, involved parties, and the outcome. These decisions are subject to regular review, ensuring they remain appropriate and responsive to the individual’s changing needs and circumstances.

8. Implementation of Physical Interventions

Physical interventions are only used as a last resort when all other de-escalation strategies have failed, and there is an immediate threat of harm to the individual, staff, or others. The decision to implement physical interventions must be guided by the principles of necessity, proportionality, and the least restrictive approach. {{org_field_name}} ensures that all physical interventions are carried out in line with current best practices, ethical standards, and legal requirements.

Physical interventions are only used when:

There is an Immediate Threat of Harm: Physical intervention is considered only when there is an imminent risk of serious harm to the individual, staff, or others. This includes situations where verbal de-escalation, redirection, or environmental adjustments have failed to reduce the threat. The use of physical intervention must cease as soon as the risk has been mitigated.
The Least Restrictive Method Can Effectively Manage the Risk: When physical intervention is unavoidable, the least restrictive method is employed to achieve the desired outcome. This means choosing an intervention that minimises the restriction of movement while ensuring safety. For example, guiding an individual away from danger using open-palm techniques rather than applying a hold.
Staff Have Been Trained in Safe Intervention Techniques: Only staff who have completed certified training in positive behaviour support and physical intervention techniques are authorised to implement such interventions. Training covers safe holds, breakaway techniques, and the psychological impact of restraint. Staff are also trained to monitor the individual’s physical and emotional well-being during and after the intervention.

Additional Safeguards:

Continuous Monitoring: During any physical intervention, the individual’s breathing, circulation, and overall well-being must be continuously monitored. If the individual shows signs of distress, the intervention must be stopped immediately, and appropriate medical attention sought if necessary.
Post-Incident Support: Following any physical intervention, both the individual and staff involved must receive support. This includes a debriefing session to discuss what led to the intervention, how it was handled, and how future incidents can be prevented. The individual’s care plan and risk assessment are reviewed and updated accordingly.
Documentation and Reporting: Every incident involving physical intervention must be fully documented, including the circumstances leading to the intervention, the type of intervention used, its duration, and the outcome. Any injuries sustained by the individual or staff must be recorded, and the incident must be reported to senior management for further review.
Ethical Considerations: Physical interventions must never be used as a form of punishment, coercion, or convenience. The dignity and rights of the individual must be maintained throughout the intervention process. Staff are reminded that their primary role is to provide care and support, not control or domination.
Family and Advocate Involvement: Where appropriate, family members, advocates, or legal representatives must be informed about the incident. Their insights can help in reviewing care strategies and ensuring that future interventions are avoided whenever possible.

By adhering to these guidelines, {{org_field_name}} ensures that physical interventions are implemented safely, ethically, and as a measure of absolute last resort.

9. Training and Staff Competency

All staff receive regular training in:

Positive behaviour support.
Safe physical intervention techniques.
De-escalation and conflict management.

Training records are maintained and updated regularly.

10. Recording and Reporting

Every use of restrictive practice is documented, including:

The reason for the intervention.
The type of restraint used.
The duration and outcome.
Any injuries sustained.

Reports are reviewed by management to identify trends and improve practices.

11. Monitoring and Quality Assurance

We regularly audit restrictive practices through:

Reviewing care plans and risk assessments.
Conducting staff and service user feedback sessions.
Analysing incident reports and identifying areas for improvement.

12. Safeguarding and Complaints Procedure

Any misuse of restrictive practices is treated as a safeguarding concern and reported according to our Safeguarding Policy. Service users and families can raise concerns through our complaints process.

13. Review and Continuous Improvement

This policy is reviewed annually or after any significant incident. Feedback from staff, service users, and stakeholders informs policy updates.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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