Key Points to Note from the HIQA Restrictive Practices Thematic Inspection Guidance Documents

Are you aware that the Health Information and Quality Authority (HIQA) will be conducting thematic inspections of restrictive practices in residential homes across Ireland this year? Is your residential home prepared for the thematic inspection?

HIQA recently published several guidance documents relating to the use of restrictive practice within Designated Centres for Older People. The documents published include:

1. “Guidance on Promoting a Care Environment that is Free from Restrictive Practice” (March 2019)
2. “Self-Assessment Questionnaire – Restrictive Practice Thematic Programme” (March 2019)
3. “Restrictive Practice Thematic Programme Quality Improvement Plan” (March 2019)
4. “Assessment Judgement Framework for Thematic Inspections of Restrictive Practices” (March 2019)

The thematic inspection programme will focus on assessing environmental and physical restraint (incorporating mechanical restraint) as well as other forms of restrictive practices. The use of chemical restraint will not be assessed as part of the thematic programme. The thematic inspections will primarily utilise the National Standards for Residential Care Settings for Older People in Ireland, 2016.

Key points to note from the restrictive practice thematic inspection guidance include:

• Governance – Governance arrangements must be in place within the residential home that monitor the use of restrictive practices and ensure residents’ rights are protected and promoted at all times. The residential home must promote a restraint-free environment for residents and the residential home must aim to reduce or eliminate the use of restrictive practices wherever possible. The residential home must ensure that the appropriate resources, such as staffing, are in place.
• Assessment and Ongoing Review of the Use of Restrictive Practices – A questioning attitude to the use of any restrictive practices must be evident within the residential home. The use of restrictive practices must be assessed and subject to ongoing review on a Multi-disciplinary basis. All residents must be assessed prior to the use of a restrictive practice and ongoing assessment and review must take place as the resident’s needs and requirements for support change over time.
• Residents’ Dignity and Quality of Life Not Unduly Compromised – Where restrictive practices are deemed necessary, they must be implemented in a way that does not unduly compromise the dignity or quality of life of the resident. The residential home must ensure the use of restrictive practices is proportionate to the identified risk.
• Consent from the Resident – Informed consent from the resident must be sought prior to use of any restrictive practice. Where a resident does not have capacity to consent, the residential home must consult with the resident’s legal representative or independent advocate to ensure the resident’s privacy, dignity and rights are respected in line with the proposed practice. It is important to note that capacity must be viewed in functional terms. This is in line with the Assisted Decision-Making (Capacity) Act, 2015 and ensures that where a resident lacks decision-making capacity in one matter at a particular time, it does not mean that they lack capacity in other matters or at another time.
• De-briefing Sessions Take Place Following Unplanned or Emergency Situations – Where restrictive practice is used in an unplanned or emergency situation within the residential home, a de-briefing session must take place as soon as possible. The de-briefing session must provide staff with an opportunity to explain to the resident the reason for using the restrictive practice and also for the resident to ask any questions they may have.
• Data Analysis of the Use of Restrictive Practices –The residential home must collect and analyse data to identify trends in the use of restrictive practices. This must be completed in line with Data Protection requirements.

For further information on the care tools provided by HCI in relation to Restrictive Practices, contact HCI at +353 (0)93 36126 or info@hci.care or visit the HCI Care Tools website www.hcicaretools.com.

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References

Health Information and Quality Authority (2019). Guidance on Promoting a Care Environment that is Free from Restrictive Practice. Cork: Health Information and Quality Authority.

Health Information and Quality Authority (2019b). Self-Assessment Questionnaire – Restrictive Practice Thematic Programme. Cork: Health Information and Quality Authority.

Health Information and Quality Authority (2019c). Restrictive Practice Thematic Programme Quality Improvement Plan. Cork: Health Information and Quality Authority.

Health Information and Quality Authority (2019d). Assessment Judgement Framework for Thematic Inspections of Restrictive Practices. Cork: Health Information and Quality Authority