Practical Application of the HIQA Restrictive Practices Thematic Inspection Guidance Documents

Is your residential home prepared for a HIQA thematic inspection of restrictive practices? If you are not sure, then read below for an insight on the practical application of HIQA’s requirements for restrictive practice in Designated Centres for Older People.

HIQA recently published several guidance documents relating to Restrictive Practices: Thematic Inspections of Designated Centres for Older People, which are available to download from //www.hiqa.ie/reports-and-publications/guide/guidance-restrictive-practice-dcop.

The restrictive practice 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.

In order to ensure compliance, the residential home must ensure the following are in place:

• Self-Assessment Questionnaire – A self-assessment questionnaire must be completed prior to the HIQA thematic inspection process. The aim of the self-assessment is to identify areas where improvement is required in relation to restrictive practices. The Inspector shall also use the findings to compare with inspection findings.
• Quality Improvement Plan (QIP) – The QIP is initiated in response to the findings from the self-assessment questionnaire. The residential home does not submit a completed QIP to HIQA, however, it is made available to the Inspector upon request during an on-site inspection. The QIP is used to identify what improvements are identified as needed, how they were completed and the ongoing monitoring process. HIQA have developed a QIP template for residential homes, however, any QIP tool or template may be utilised once it incorporates the key areas set out in HIQA’s document.
• Policy and Procedure on Restrictive Practices – A policy and procedure on the use of restrictive practices must be developed in line with National Policy, relevant legislation, regulations and enactments and implemented within the residential home. The restrictive practices policy and procedure must contain the following:
  • A commitment to promoting a restraint-free environment.
  • Assessment of restrictive practice use.
  • Monitoring, recording and reviewing the use of restrictive practices.
  • Guidance on the use of restrictive practice in an unplanned or emergency situation.
  • Governance arrangements for monitoring and auditing the use of restrictive practices.
• Assessment and Review – A questioning attitude must be adopted against the use of any restrictive practices that are in place in the residential home. The residential home must carry out a comprehensive assessment of a resident’s needs and it must be stored in the resident’s record. The use of restrictive practices must be assessed on a Multidisciplinary basis and subject to ongoing review.
• Monitoring, Recording and Review of Restrictive Practices – Data must be collected and analysed to identify trends in the use of restrictive practices within the residential home. The residential home must conduct reviews to consider whether the use of restrictive practices is valid for the resident. These reviews must provide an opportunity to reduce or eliminate the use of restrictive practices and to trial alternatives for the resident.
• Governance – The residential home must ensure the appropriate resources, such as staffing, are in place to support residents. The residential home must aim to promote a restraint-free environment and ensure appropriate governance arrangements are in place to monitor the use of restrictive practices and to ensure residents’ rights are promoted.

For further information on the care tools provided by HCI in relation to Restrictive Practices, or would like information on an independent Restrictive Practice Audit against the guidelines, then contact HCI at +353 (0)93 36126 or info@hci.care.

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.