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Least Restraint

Restraint is the use of any mechanical, physical, environmental or pharmacological method to control behaviour. The Patient Restraint Minimization Act of Ontario was passed in 2001 and was the first legislation in Canada regarding the use of restraints.

This Act governs the policy and procedures for hospitals. The Mental Health Act which is very similar, provides legislation for the mental health population, and the long term care setting has standards available that guide institutional practice. There is a growing body of evidence that supports restraint free care or little restraint use at all, for the least possible time.

It is encouraged that the family provide support by providing familiarity and care in collaboration with the health care team where possible. Restraints are often considered when changes occur such as challenging behaviours, aggression, self-harm or harm to others or in order to prevent removal of medical devices, or to address concerns regarding patient safety such as possible falls or wandering.

The use of restraints may be more prevalent in the older population. It is the goal of caregivers to assess all behaviour, review the possible reasons for the behaviour and to initiate alternatives to restraints. The growing body of evidence does not support the use of restraints in all of the above situations.

A primer for Health Care Professionals entitled What you need to know to work with persons with Dementia: A Primer for those starting to work in dementia care has been published by the Champlain Dementia Network.