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A3 Poster: Making a decision about how to respond to a behaviour of concern in a residential aged care facility

A person-centred approach is a restraint free approach – a way of thinking that preserves the human rights of any person. All residents are entitled to respect and protection of their basic rights and freedoms, regardless of where they live. This entitlement includes all persons bearing a corresponding obligation to respect and protect the rights and freedoms of others.

PDF printable version of Making a decision about how to respond to a behaviour of concern in a residential aged care facility (PDF 310 KB)

Trigger

A Resident poses a risk to themselves or others

Action

Ensure immediate safety of all concerned

Consider possible causes

Deal with the cause and provide restraint free care

Review care plan

Has this behaviour and its management been identified in the care plan?

Yes

Care plan is clear

Follow resident’s care plan

Ongoing documentation and evaluation

If review care plan is No

Behaviour not previously identified

Communicate with supervisor

Meet basic comfort and use restraint free care

Establish possible cause of behaviour – look for triggers and continue with restraint free care

OK?

Observe and monitor resident. Update care plan

Ongoing documentation and evaluation

If Not OK

Behavious is escalating

When all restraint free options have been exhausted

Communicate with supervisor, resident, family and relevant health care team members to discuss options. Ensure safety of resident

Use temporary and least restrictive form of restraint with a clearly identified review process

Observe and monitor resident ensuring safety and comfort. Return to restraint free care as soon a possible. Update care plan
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Ongoing documentation and evaluation

Restraint free options

Environmental

• Improved lighting
• Lights that are easy to use
• Non-slip flooring
• Carpeting in high-use areas
• Ensure a clear pathway
• Easy access to safe outdoor areas
• Activity areas at the end of each corridor
• Lowered bed height to suit individual needs
• Remove wheels from beds
• Appropriate mobility aids close at hand (railings on the wall, trapeze to enhance mobility in bed)
• Appropriate signage and visual reminders to aid orientation (e.g. use pictures)
• Seating to meet the needs of individual residents
• A quiet area
• Reduce environmental noise
• Safe areas for residents to wander such as circular corridors with activity stations
• Protected outdoor areas
• Transfer rails
• Provide familiar objects from the resident’s home (e.g. photo albums, furniture etc)
• ‘Snoozelen’ room
• Appropriate alarm systems to alert staff to risky situations (e.g. a resident who has wandered into a dangerous area)

Activities and programs

• Rehabilitation and/or exercise
• Regular ambulation
• Continence program
• Physical, occupational and recreational therapies
• Exercise program
• Night-time activities
• Individual and group social activities
• Appropriate outlets for industrious people (e.g.. gardening, folding linen)
• Facilitate safe wandering behaviour
• Falls prevention program
• Activities box containing, for example, laundry to fold, stuffed animals, purses and wallets
• Offer a change of seating arrangements at regular intervals with their consent, for residents who are not independently mobile

Alterations to nursing care

• Know the residents as individuals
• Increased supervision and observation
• Regular evaluation and monitoring of conditions that may alter behaviour, e.g. noise level
• Increased staffing level
• Individualised routines e.g. toileting, naps
• Structured routine
• Check ‘at-risk’ residents regularly
• Appropriate footwear
• Body padding (hip protectors)
• Better communication strategies

Physical strategies

• Comprehensive physical check-up
• Comprehensive medication management review
• Treat infections
• Pain management
• Physical alternatives to sedation (e.g. warm milk, soothing music)

Psychosocial programs and therapies

• Companionship
• Active listening
• Visitors
• Staff/resident interaction
• Familiar staff
• Therapeutic touch
• Massage
• Relaxation programs
• Reality orientation
• Sensory aids
• Sensory stimulation
• Decreased sensory stimulation

Adapted from Joanna Briggs Institute (2002) Physical Restraint – Pt 2; Minimisation in Acute and Residential Care Facilities. Best Practice, Vol 6 Issue 4, Blackwell Publishing Asia,, Australia.
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