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Where restraint is clinically necessary to prevent harm, the health service organisation has systems that:
Harm relating to the use of restraint is minimised. Reflective questionsWhat strategies does the health service organisation have in place to minimise the use of restraint? Are members of the workforce competent to implement restraint safely? How does the health service organisation ensure that the workforce is aware of safety implications of different forms of physical and mechanical restraint with different patient populations? What processes (for example, benchmarking, routine review) are used to review the use of restraints in the health service organisation? Key tasks
Strategies for improvement
Seclusion is the confinement of a person, at any time of the day or night, in a room or area from which free exit is prevented. Under the Act, seclusion may only be used for an involuntary patient in an authorised mental health service (AMHS) who is subject to a treatment authority, forensic order or treatment support order, or a person absent without permission from another State who is detained in an AMHS. Seclusion may be authorised by an authorised doctor for up to three hours and for no more than nine hours in a 24-hour period. Seclusion cannot be authorised under an advance health directive, or with the consent of a guardian, attorney or, if the person is a minor, the minor’s parents. A patient in seclusion must be observed at intervals of no more than 15 minutes for the duration of the seclusion and must be removed from seclusion if it is no longer necessary to protect the person or others from physical harm. Policy: Seclusion Form: Authorisation of Seclusion Form: Release and Return to Seclusion Flowchart: Authorisation of Seclusion and Emergency Seclusion Emergency seclusionIn an emergency, a health practitioner in charge of a unit within an AMHS may seclude a person for up to 1 hour until an authorised doctor is available to complete the authorisation of seclusion. Emergency seclusion may be authorised for no more than 3 hours in a 24-hour period. Form: Emergency Authorisation of Seclusion Extension of seclusion – reduction and elimination planIf seclusion is required to be extended beyond the authorised time, continuation of seclusion may be approved under a reduction and elimination plan. If required, a 12-hour extension of seclusion may be authorised to allow a reduction and elimination plan to be prepared for the patient. Form: Extension of Seclusion Form: Reduction and Elimination Plan - Seclusion and Mechanical Restraint Flowchart: Reduction and Elimination Plans and Extension of Seclusion High secure unitsA high security unit authorised mental health service provides treatment and care to patients with significantly challenging behaviours whose risk of harm to self or others cannot be safely managed in a less secure environment. Some patients may require extended periods of seclusion to ensure their own or others’ safety. Consistent with national priorities, the aim is to minimise the use of seclusion for these individuals while ensuring a safe environment for the patient and others. Policy: Overnight confinement for security purposes at High Secure Units Restrictive interventions involve the use of bodily restraint (physical and mechanical restraint) and seclusion. The regulation of restrictive interventions applies to all people receiving mental health services in a designated mental health service regardless of the person’s legal status under the Mental Health Act 2014 or age. The Victorian Government is committed to reduce and wherever possible eliminate the use of restrictive interventions. The use of a restrictive intervention on a person receiving mental health services in a designated mental health service must beauthorised by: An authorised psychiatrist or delegate must be notified as soon as practicable if the restrictive intervention is authorised by a registered medical practitioner or the senior registered nurse on duty. The authorised psychiatrist or delegate must then examine the person as soon as practicable to decide whether continued use of the restrictive intervention is necessary. If the authorised psychiatrist or delegate is not available to examine the person, he or she must arrange for a registered medical practitioner to examine the person to decide whether continued use of the restrictive intervention is necessary. Urgent physical restraintThe use of urgent physical restraint on a person receiving mental health services in a designated mental health service may be approvedby a registered nurse. The registered nurse may only approve urgent physical restraint if:
Use of restrictive interventionsA restrictive intervention may only be used on a person receiving mental health services in a designated mental health service after all reasonable and less restrictive options have been tried or considered and have been found to be unsuitable. A restrictive intervention may only be used where it is necessary to prevent serious and imminent harm to the person or another person. Bodily restraint may also be used where necessary to administer treatment or medical treatment. The senior registered nurse on duty, a registered medical practitioner or an authorised psychiatrist or delegate must immediately release the person from the restrictive intervention as soon as the grounds for the use of the restrictive intervention no longer apply. Urgent physical restraintThe use of urgent physical restraint without authorisation must be for the minimum time necessary to:
Notification of support personsAn authorised psychiatrist or delegate must take reasonable steps to ensure that, as soon as practicable after commencement of the use of a restrictive intervention on a person, the following persons (as applicable) are notified of its use, the type of restrictive intervention and the reasons for using it:
SafeguardsHigh levels of clinical care, monitoring and reporting are required when restrictive interventions are used. The authorised psychiatrist has increased responsibilities for oversight of authorisation and continued use of restrictive interventions. The person who authorises the use of a restrictive intervention must ensure that the person’s needs are met and the person’s dignity is protected by the provision of appropriate facilities and supplies, including bedding and clothing appropriate to the circumstances, food and drink and adequate hygiene and toilet arrangements. A person being bodily restrained (including urgent physical restraint) must be under continuous observation by a registered nurse or registered medical practitioner. A registered nurse or registered medical practitioner must:
An authorised psychiatrist or delegate must examine a person in seclusion or being bodily restrained as frequently as the authorised psychiatrist is satisfied is appropriate in the circumstances to do so, but not less frequently than every four hours. If it is not practicable for an authorised psychiatrist or delegate to conduct an examination at the frequency that the authorised psychiatrist or delegate is satisfied is appropriate, the person must be examined by the registered medical practitioner when so directed by the authorised psychiatrist, but not less frequently than every four hours. The authorised psychiatrist must provide a written report to the Chief Psychiatrist about the use of restrictive interventions in the designated mental health service. The report will be generated through the CMI/ODS. |
What are the legal requirements of nursing and medical staff for the use of seclusion
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