by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Australian Journal of Pharmacy : October 2006
y education Other forms of treatment include: • Community support including information, accommoda- tion, help with finding suitable work, training and education, psychosocial rehabilitation and mutual support groups. • Electroconvulsive therapy (ECT) can be a highly effective treatment for severe depression where other treatments have not been effective. Hospitalisation only occurs when a person is acutely ill and needs intensive treatment for a short time. It is considered bet- ter for a person’s mental health to treat them in the community, in their familiar surroundings. Involuntary treatment can occur when the psychiatrist, or psychogeriatrician recommends someone needs treatment but the person does not agree. In general, people receive involuntary treatment to ensure their safety, or that of others. This situation may arise in aged care homes, particularly with residents suffering dementia or delirium. Restraint is the act of removing another person’s freedom. It is sometimes considered in a number of situations including: • resident requests to prevent falling; • family requests to prevent resident falling; • care staff concern to prevent resident falling; and • care staff concern to manage resident’s behaviour. Whether this act is in the resident’s best interests in any of the above situations must be determined for an individual resident in a specific situation. Physical and chemical restraint orders may be required, which require regular review. The publication Deci- sion-making tool: Responding to issues of restraint in aged care published by the Department of Health and Ageing offers guidelines for preventing and responding to behaviours of concern.4 A family member or legal representative does not have legal power to require that a resident be restrained. This is a clinical decision that must be made by appropriately qualified people. The reasons for the decision to restrain and the process by which the decision was reached should be documented, as those mak- ing the decision are legally accountable for the decision and its consequences. Any decision to restrain a resident carries signifi- cant ethical and legal responsibilities.4 General restraint devices Concave mattresses Lap rugs with ties deep seats, belts, recliners, wheel chair safety devices Bed boundary markers Skeletal support THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 OCTOBER 2006 ? 79 Perimeter restraint AJPCPE CONTINUING PROFESSIONAL EDUCATION Chemical restraint The intentional use of medication to control a resident’s behav- iour when no medically identified condition is being treated, where the treatment is not necessary for the condition or amounts to over-treatment of the condition is chemical restraint.4 Chemical restraint includes the use of medication when the behaviour to be affected by the medication does not appear to have a medical cause and part of the intended pharmacological effect of the drug is to sedate the person for convenience sake or disciplinary purposes. Examples of pharmacological agents used as chemical restraint are antipsychotic, antidepressant, anti- manic, anxiolytic and hypnotic drugs. Audits in aged care homes show that chemical restraint orders are rarely used—in most cases there is an underlying medical condition which is being treated by these agents. Diversional therapies are used routinely in most aged care homes in favour of medication. Physical restraint The intentional restriction of a resident’s voluntary movement or behaviour by the use of a device, or removal of mobility aids, or physical force for behavioural purposes is physical restraint. Physical restraint devices include, but are not limited to, lap belts, tabletops, posey restraints or similar products, bed rails, and chairs that are difficult to get out of such as beanbags, water- chairs and deep chairs. Immobilisation through restraint can result in chronic consti- pation, incontinence, pressure sores, loss of bone and muscle mass, walking difficulties, increased feelings of panic and fear, boredom and loss of dignity. Table One outlines variations of restraint and Table Two offers some alternatives to restraint. The pharmacist’s dilemma when undertaking medication reviews in an aged care setting is to establish the use of pre- scribed antipsychotic, antidepressant, mood stabilising, anxi- olytic or sedative medication. Was the medication started before the resident came to the facility for an existing diagnosis, for example schizophrenia, bipolar, long standing psychosis? Is there a new indication or has the medication been started to Table One: Restraint variations (adapted from 4,5) High risk restraint Exit doors with keypads Locked exit doors to facility or activity area Restrictive seating, for example, Fenced area with locked gates Chemical, that is, medications that sedate or tranquillise Removal of mobility aids Bedrails Person to person Physical force/hands on Psychological measures, for example, tape across a door Verbal—commands, threats