CMPA Perspective March 2016
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safe systems<br />
medical-legal implications<br />
when using restraints<br />
When there’s a possibility that patients may harm themselves or others, physical or chemical restraint<br />
may be required. However, the use of restraints is not without risk. Injuries to staff and patients, cardiorespiratory<br />
problems, sudden unexpected death, stress, reduced psychological well-being for staff and<br />
patients, and decreased mobility, can all be associated with the use of restraints. 1<br />
What can physicians do to reduce the risk?<br />
Legislation and best practices on the use of<br />
restraints offer strong guidance. As well, the<br />
experts involved in the <strong>CMPA</strong>’s medical-legal<br />
cases involving restraints identified what doctors<br />
can do to make restraints safer, such as clearly<br />
communicating with patients about restraint use<br />
and effectively monitoring restrained patients.<br />
The <strong>CMPA</strong>’s experience<br />
A 10-year review of the Association’s cases revealed<br />
69 closed medical-legal matters involving the use<br />
of restraints: 36 legal cases, 26 regulatory authority<br />
(College) complaints, and 7 hospital matters.<br />
The doctors most often involved were psychiatrists,<br />
emergency physicians, and family physicians with<br />
emergency room privileges.<br />
In the analyzed cases, restraint was commonly<br />
used to contain violent behaviour, reduce the<br />
potential for the patients to harm themselves or<br />
others, and allow physicians to conduct a proper<br />
assessment. Typically, restraint was initiated<br />
when other less invasive means of de-escalating a<br />
situation had failed.<br />
Mental health and substance use issues were<br />
prevalent among the patients in the studied<br />
cases. Of the patients with these issues, half<br />
complained about the use of involuntary admission<br />
and chemical or physical restraint. Yet, all such<br />
complaints had favourable outcomes, with experts<br />
in the cases acknowledging that restraint was<br />
required for the safety of the patient or others.<br />
6 cmpa perspective | march <strong>2016</strong>