Read our policy and vision on coercive measures / freedom restricting measures here.
Restraint measures in the hospital refer to all the measures and means used to limit a patient’s freedom of movement. Such measures may only be considered in the context of safety or for administering a life-saving treatment.
The hospital pursues a low-restraint policy. This means looking for preventive means and less invasive alternatives, and restraining the patient only if there is no other option and for as short a period as possible. Our policy guidelines: staff training, consultation with patients and their relatives, consulting the supporting patient file, and frequent evaluation of the measures and policies.
There are restraint measures that limit the patient’s freedom of movement by confining them to the room or ward. The patient is not physically restrained and can still walk around freely within that space. This is achieved by placing door barriers, making the patient wear an armband with an alarm or keeping the patient in a ward where the entrance door is secured.
The most widely known measures are referred to as physical restraints. This includes any action or the use of equipment or medication that limits, prevents or hinders a person’s freedom of movement, whereby the person is unable to regain their freedom of movement independently. This refers to situations where the person is physically confined to a bed or chair using, for example, wrist straps, restraint gloves, belt restraints (for securing the person to a chair), bed rails, chairs with tables attached, safety restraint sheets, etc.
Isolation/seclusion of a patient is another possible measure. For this, the patient is placed alone in a specially designed seclusion room or in another separate room which the patient cannot leave independently. In Geriatrics, the timeout room may be used for this purpose. This is a safe, low-stimulation room where patients can calm down, without any physical restraints being involved. Increased supervision is possible via a camera. At A&E, there is an isolation room that is used in extreme emergencies. Physical restraint at the bedside may be used and increased supervision via a camera is provided for.
Forced medication refers to sedatives (e.g. tranquillisers), prescribed by a doctor to control anxiety or aggression in patients in extreme situations and to calm the patient. This may be administered to (1) persons who are able to consent but refuse to do so or (2) persons who are unable to consent but who oppose the administration of the medication. Sometimes a combination of measures such as physical restraints and/or an isolation room may be temporarily necessary.
The restraint measures, excluding physical restraints, are applied by the team, in consultation with the patient and or his/her informal carer as far as possible. Here, safety is the primary concern, where a disoriented patient or patient with wandering behaviour can walk around freely without being able to enter other rooms or leave the hospital.
A restraint measure can also be applied at the request of a patient or family member. For example, a patient may ask for the bedrails to be raised to have something to hold onto or out of fear of falling out of bed.
Measures to restrain patients physically are used as a last resort if preventive measures do not help and if safety is compromised or the treatment cannot be guaranteed.
In the absence of any prior consultation with the patient and/or their family, caregivers may use restraint measures only in case of emergencies. Two indications for this are to prevent the patient from harming themself or others or to enable them to receive life-sustaining treatment. These situations often involve the use of physical restraints, the isolation room or sedatives. Naturally, the family will be informed as soon as possible in such cases. As soon as the patient’s condition allows for this, the measures taken will be communicated and reduced as soon as possible. When taking such measures, we consider how this is perceived by the patient and their loved ones and try to reduce its impact.
Every restraint measure is based on a decision that is taken for each patient individually. The advantages and disadvantages are carefully considered so that the least invasive measure can be used. If possible, we consult the patient, their family or legal representative beforehand.
In the absence of any prior consultation, we will use restraint measures only in urgent situations. In that case, we will inform the family about this as soon as possible and be happy to give them an explanation during their next visit.
Every day, the care team evaluates the need for the measures, how they can be reduced and whether there are alternatives. The family is an indispensable link in these considerations.
Information about the measures, such as the motivation for their use, duration of use, evaluations and the persons involved in the consultation, is maintained in the patient file. The risks to be monitored are also included in this file. Strict attention is paid to aspects such as the increased monitoring of the patient’s basic needs, providing the patient and their family with sufficient support and the prevention of complications due to the restraint measures.
If the isolation procedure and/or forced medication are/is used, a record is kept of all observation periods. These observations take place at least once every hour and a half. Given the serious psychological impact on the patient, the procedure will be used for as short a time as possible. The necessity of the procedure is evaluated at the time of each observation.
The presence of family members can have a positive influence on the patient’s behaviour. Physical restraint measures may sometimes be removed during the visit or less invasive alternatives may be tried out, which is helpful for reducing the measures.
As a family member, feel free to let us know what you think has a reassuring effect on the patient. Bring something recognisable from home, such as a photo, a clock, etc.
If possible, spread out the visits among various family members so that someone familiar is in the room most of the time.
Discuss the measures with the team: how they affect the patient and you, what further information you need and what information might be useful for the care team, etc.
Download our brochure here.
