LASA forwards Member queries about the SIRS and new restrictive practices legislation to the Aged Care Quality and Safety Commission (ACQSC). See some of the member queries about restrictive practices and the ACQSC responses received below:

Consent for use of medications prescribed for PHN use
  1. We get a consent form signed by the GP and EPOA/NOK for the permission to administer the chemical restraint on a PRN basis. The use is then reviewed by the GP monthly if still required the GP resigns the consent form, but not by the EPOA/NOK as their consent is ongoing, until the GP deems it is no longer required. I am guessing most facilities do it this way, as it is not possible or even suitable to gain consent each time you need to administer a PRN chemical restraint as the resident is usually distressed or agitated. 

Can you please confirm that we need to gain consent each and every time prior to a PRN being administered?

ACQSC response:

The Aged Care Quality and Safety Commission (the Commission) focus is to ensure that risks to consumers’ safety, health and well-being through the use of restrictive practices are minimised, and consumers are treated with dignity and respect.

From 1 July 2021, approved providers have updated and specific responsibilities under the Aged Care Act 1997 and the Quality of Care Principles 2014 relating to the use of any restrictive practice in residential aged care and short-term restorative care in a residential care setting. Under the amended legislation, the Quality of Care Principles require providers to satisfy a number of conditions before and during the use of any restrictive practice. This information is outlined in the recent Regulatory Bulletin, available at https://www.agedcarequality.gov.au/providers/assessment-processes/minimising-restrictive-practices

From 1 July 2021, restrictive practices must only be used where the provider has documented changed behaviours (or behaviours of concern) for the consumer, where these changed behaviours have been assessed by an approved health practitioner who has day to day knowledge of the consumer, or a behaviour support specialist, alternative strategies have been used prior to the use of any restrictive practice, and consent to the use of any restrictive practice if required. This process builds on existing strategies a provider should already have in place under the Principles (as expired on 30 June 2021).

Chemical restraint is defined under the Principles as a practice or intervention that is, or that involves, the use of medication or a chemical substance for the primary purpose of influencing a consumer’s behaviour, but does not include the use of medication prescribed for:

(a) the treatment of, or to enable treatment of, the consumer for:

(i)    a diagnosed mental disorder; or

(ii) a physical illness; or

(iii) a physical condition; or

(b) end of life care for the consumer.

Consistent with previous legislative requirements on the use of restraint, providers are expected to have individual care and services plans in place which outline a consumer’s behaviour support needs, including for the use of physical or chemical restraints, which may be used on a PRN basis. These requirements are that providers have documented evidence that other strategies were used prior to the application or use of the restrictive practice as a last resort, have documented evidence of consent for use of the restrictive practice, and evidence of ongoing monitoring and evaluation for its continued use. Consent for use of any type of restrictive practice is required and should be documented in the consumer’s care and services plan.

If the GP has gained consent for use of a medication prescribed for PRN use, and this consent is documented, then consent does not need to be gained each time a medication is given on a PRN basis. However, if a medication prescribed as PRN is being employed on a regular basis, this is considered as routine medication administration, and alternate strategies should be employed and exhausted and the restrictive practice used as a last resort. Dementia Support Australia has a number of resources available to support providers with behaviour management strategies for consumers. These resources are available at https://dementia.com.au/

Restrictive practices and IPC and when is redirection a restrictive practice
  1.      Staff at one facility ask whether when implementing visitor restrictions under advice by the Chief Health Officer could be considered a restrictive practice.

Further, infection prevention and control measures, such as cohorting residents in a wing and not allowing them to mingle with residents in other parts of the care home could be considered a restrictive practice.

ACQSC response:

Isolating a consumer in response to a public health order is not a restrictive practice as the isolation of the care recipient is not undertaken for the primary purpose of influencing behaviour.

Section 15E(6) of the Principles advises seclusion is a form of restrictive practice, involving solitary confinement of a care recipient in a room or a physical space at any hour of the day or night where:

  • voluntary exit is prevented or not facilitated
  • it is implied that voluntary exit is not permitted

for the primary purpose of influencing the care recipient’s behaviour.

  1.      When a resident is intruding into another resident’s room, does redirection away from that space become a restrictive practise?
ACQSC response:

Redirection of a resident away from another resident’s room may not be physical restraint, dependent on how this is done.

Section 15E(5) of the Principles states Physical restraint is a practice or intervention that:

  • is or involves the use of physical force to prevent, restrict or subdue movement of a care recipient’s body, or part of a care recipient’s body, for the primary purpose of influencing the care recipient’s behaviour
  • but does not include the use of a hands‑on technique in a reflexive way to guide or redirect the care recipient away from potential harm or injury if it is consistent with what could reasonably be considered to be the exercise of care towards the care recipient.

If care recipients need to be prevented from entering another resident’s room, approved providers need to be mindful of responsibilities relating to behaviour support plans (section 15HA of the Principles) and matters to be set out in behaviour support plans (section 15HB of the Principles).

  1.      When staff intervene and have to prevent a resident hurting another resident – if done reasonably, is that considered restrictive practise?
ACQSC response:

Intervention by staff to prevent one resident from hurting another – if done reasonably – may not constitute a restrictive practice, dependent on how this is done.

Section 15E(5) of the Principles states Physical restraint is a practice or intervention that:

  • is or involves the use of physical force to prevent, restrict or subdue movement of a care recipient’s body, or part of a care recipient’s body, for the primary purpose of influencing the care recipient’s behaviour
  • but does not include the use of a hands‑on technique in a reflexive way to guide or redirect the care recipient away from potential harm or injury if it is consistent with what could reasonably be considered to be the exercise of care towards the care recipient.

As noted in the response to Question 3, if staff need to intervene to stop one care recipient from hurting another, approved providers need to be mindful of responsibilities relating to behaviour support plans (section 15HA of the Principles) and matters to be set out in behaviour support plans (section 15HB of the Principles).

  1.      When a staff remove a person to a quieter area for their own wellbeing when in an agitated state – is that considered seclusion?
ACQSC response:

Removal of a care recipient to a quieter area for their own well-being when in an agitated state may not necessarily constitute seclusion. Seclusion involves solitary confinement, so the movement of a care recipient to a quieter, environment shared with other care recipients would not be secluding the care recipient in question.

As noted in the response to question 1, section 15E(6) the Principles states seclusion is a form of restrictive practice, involving solitary confinement of a care recipient in a room or a physical space at any hour of the day or night where:

  • voluntary exit is prevented or not facilitated
  • it is implied that voluntary exit is not permitted

for the primary purpose of influencing the care recipient’s behaviour.

Should the care recipient be moved into a quieter area with the result that they are isolated and voluntary exit is prevented, not facilitated, or it’s implied that voluntary exit is not permitted, this would constitute seclusion.

Approved providers would need to be mindful of the manner in which care recipients should be redirected to the quieter area and matters to be set out in behaviour support plans (refer to the responses to questions 2 and 3).