Deaths associated with restraint use in health and social care in the UK. The results of a preliminary survey

Abstract

Many aspects of the management of acutely disturbed behaviour have only relatively recently come under systematic scrutiny. Perhaps regrettably one of the last amongst the range of strategies that may be employed to be subjected to rigorous examination has been physical restraint. Considerable debate has recently taken place around what represents good practice in this sensitive and controversial area but the continuing dearth of research in some aspects of this area of practice has meant that this discussion has arguably been over reliant on 'expert' opinion. Questions continue regarding some fundamental issues of restraint, including the relative risks involved in alternative approaches, and anxieties have been expressed about the potential for injuries and death to result from restraint. This article outlines the results of a survey that sought to explore the incidence of deaths associated with restraint in health and social care settings in the UK. The outcome of an initial analysis of the cases identified is then discussed, with reference to the literature on restraint-related deaths, in order to identify the implications for practice.

Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

“…Some forms of manual restraint involve face-down (prone) restraint, which has been associated with sudden 21 death. 48 The struggle of the patient to gain control from restraint can itself lead to staff and patient injury. Information about the use of manual restraint as a management method in psychiatric hospitals is sparse and little is known about instances in which manual restraint might be used and the point at which it will be instigated when risk behaviour is displayed.…”

Prevention and Management of Aggression Training and Violent Incidents on U.K. Acute Psychiatric Wards

“…Although the majority of such attacks result in little or no physical injury, psychological responses can be significant, with reports of consequent anger, anxiety, post-traumatic stress disorder symptoms, guilt, self-blame and shame (Needham et al 2005). There have been additional concerns about injuries to patients during the management of violent incidents, particularly manual restraint related deaths (Blofeld et al 2003;Paterson et al 2003). …”

Desenvolvimento e avaliação da eficiência da estabilização protetora na odontopediatria: um estudo piloto

“…Além da estabilização protetora, a estabilização da cabeça da criança juntamente com o posicionamento do abridor de boca e sugador deve ser feito em equipe, para isso, a auxiliar em saúde bucal é fundamental, pois essa auxilia na redução da ansiedade e no sucesso do tratamento da criança 13 . Contudo, a contenção da região de cabeça e do pescoço deve ser realizada com cuidado, de forma que não ocorra uma pressão na região da artéria carótida, o que traria danos à integridade física do paciente 14 . É importante enfatizar que a estabilização protetora pode ser utilizada como medida terapêutica, porém com prudência para evitar a sua banalização, pois se utilizada sem corretas indicações, pode acarretar em danos físicos e psíquicos aos pacientes 15 .…”