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Inappropriate use of restrictive practices

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What is inappropriate use of restrictive practices?

Inappropriate use of restrictive practices is any use of a restrictive practice that is not consistent with the requirements in the Quality of Care Principles (2014).

Under the Quality of Care Principles, restrictive practices may only be used as a last resort, when you have tried all possible alternatives and the alternatives have not worked. The process of reaching this decision must be documented.

You must notify the Commission of any incident of inappropriate use of restrictive practices that:

  • happens in your service

  • somebody has alleged happened at your service

  • you suspect may have happened at your service.

What is a restrictive practice?

A restrictive practice is any practice or intervention that restricts the rights or freedom of movement of an aged care consumer. There are five types of restrictive practice:

•    chemical restraint

•    environmental restraint

•    mechanical restraint

•    physical restraint

•    seclusion.

More information on the five types of restrictive practice can be found in the Commission’s Overview of restrictive practices.

Some examples of restrictive practices include:
  • use of bed rails or a lowered bed that makes it difficult for a consumer to get out
  • seclusion or confinement of a consumer where voluntary exit is prevented or not facilitated
  • use of a bed belt or lap sash restraint
  • physically blocking a consumer’s path, holding onto a consumer to prevent their movement or holding a consumer down
  • removing the battery out of a consumer’s electric wheelchair or putting mobility aids out of a consumer’s reach to limit their movement.
  • any drugs used to control, sedate, or restrict movement instead of for the treatment of a diagnosed health condition.

Any use of restrictive practice that is not consistent with the Quality of Care Principles constitutes inappropriate use of restrictive practice and is a reportable incident.

Inappropriate use of restrictive practice does not include:
  • use of restrictive practice that is consistent with the Quality of Care Principles
  • use of restrictive practices without consent in an emergency, where the consumer’s substitute decision-maker is informed as soon as possible from the time of applying the restrictive practice
  • where a provider administers a drug to a consumer as prescribed for the treatment of a diagnosed health condition and this is documented.

Planning for the use of restrictive practice

It is important to carefully plan and manage the use of any restrictive practice in partnership with consumers, their representatives and health practitioners.

Before a restrictive practice is used in relation to a consumer, you must document:

  • the circumstances in which restrictive practices may be used, including the consumer’s behaviours that may require the use of restrictive practice
  • details regarding the way restrictive practice is to be used, including:
    • the type of restrictive practice and how to safely apply it
    • the duration of use
    • the expected frequency
    • the intended outcomes of using the restrictive practice.

It is also good practice to:

  • document any alternative strategies that may be used
  • document the consumer’s informed consent in the consumer’s care and services plan
  • schedule regular reviews to reassess the need for restrictive practice.
Care and services plans

Where restrictive practices are used, they must be in accordance with the consumer’s documented care and services plan.

As required by Standard 2 of the Quality Standards, care and services plans must be:

  • developed in collaboration with the consumer and others involved in the consumer’s care
  • readily available to the consumer
  • regularly reviewed for effectiveness and when circumstances change or incidents impact on the needs, goals or preferences of the consumer.

A care and services plan must include a behaviour support plan for a consumer who has restrictive practices considered, applied, or used as part of their care. More information can be found in this Commission fact sheet.

Warning signs

There may be warning signs that a consumer has been subjected to the inappropriate use of restrictive practices. These include:

  • red marks, bruising, tears or grazing on the skin that appear to be associated with a physical restraint
  • tiredness, drowsiness or confusion
  • an increase in frustration, anger, complaints
  • refusal to take medication or fearfulness of medication.

You should always investigate or escalate to the appropriate person within your service when there are changes in a consumer’s behaviour or where these warning signs are shown.



Remember, if you suspect that a reportable incident has happened, you must notify the Commission. You should not wait for definitive proof.

Responding to inappropriate use of restrictive practice

If there is evidence, an allegation, or suspicion of a consumer being subjected to the inappropriate use of restrictive practices, you must immediately ensure their wellbeing. This may include arranging medical or psychological assistance. All details of the incident must be recorded in your IMS.

If the incident may be unlawful, such as a physical assault, or if there is any ongoing danger to any person, you should also contact the police.

While managing the incident, you must practice open disclosure by communicating your provider’s remedial actions to the consumer and their family or representatives.

Reporting inappropriate use of restrictive practices

Inappropriate use of restrictive practices, like any reportable incident, must be recorded in your IMS and the Commission must be notified.

If there were reasonable grounds to contact the police, or if there was an injury that needed medical or psychological treatment to resolve, it is a Priority 1 reportable incident, and you must notify the Commission within 24 hours of becoming aware.

If there were no reasonable grounds to contact the police and no injury that needed medical or psychological treatment to resolve, it is a Priority 2 reportable incident. In that case, you must notify the Commission within 30 days of becoming aware.

A quality incident notification requires more than simply transcribing the details from progress notes about the incident or copying text from your IMS. It is important that the person making the notification is familiar with:

  • what happened
  • when the incident happened
  • where the incident happened
  • who was involved, including the affected consumer, workers involved in the incident, and other affected people
  • what actions were taken after the incident
  • what caused the incident (if known)
  • what changes will be made as a result of the incident (if known).

If you become aware of further information after submitting an initial notification, you must update the Commission.

When you provide clear and comprehensive information early on, it is less likely that the Commission will need to:

  • ask for further details
  • require you to conduct an investigation
  • directly investigate the matter itself.

Your service must notify the Commission as soon as possible upon becoming aware of any significant new information about a reportable incident after making a notification.

Tip

It is easier to make a good quality notification to the Commission if you have the information you need at hand.

Educating workers to report incidents correctly within your IMS will make it easier to notify the Commission when a reportable incident happens.

Work tools

The fact sheet, Reportable incidents: inappropriate use if restrictive practices, provides more detailed guidance for reporting of incidents in a residential service relating to this incident type.

The example Inappropriate use of restrictive practice shows the level of detail the Commission expects when receiving a notification about this incident type.



You can use the Practical tips guide to ensure your notification contains all of the required information.

Contact us

If you have a question about the SIRS, you can call us on 1800 081 549.

This phone line is open 9 am to 5 pm (AEST) Monday to Friday and 8 am to 6 pm (AEST) Saturday to Sunday.

You can also email us at sirs@agedcarequality.gov.au.

Facilitated Workshops

The Commission provides facilitated workshops to sector participants. All current workshops are available on the Commission’s Workshop page.

Online Learning

The Commission’s Aged Care Learning Information Solution, Alis provides free online education for employees of Commonwealth-funded aged care providers, including a module covering Inappropriate use of restrictive practices.

You can access Alis at learning.agedcarequality.gov.au.

Disclaimer

The information contained on this page is intended to provide you with general guidance; however, it is your responsibility to be aware of your legislative requirements.

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Acknowledgement of Country

In the spirit of reconciliation, the Aged Care Quality and Safety Commission acknowledges the Traditional Custodians of Country throughout Australia and their connections to land, water and community. We pay our respect to their Elders, past, present and emerging and extend that respect to all Aboriginal and Torres Strait Islander peoples.