Release of Updated HIQA Restrictive Practices Thematic Inspection Guidance Document

Is your residential home aware of the updated guidance released to support HIQA’s thematic programme of inspection of restrictive practices in designated centres for Older People for implementation from June 2023?

HIQA implement thematic inspections with an aim to promoting quality improvement in a specific aspect of care, in this instance, restrictive practices. This thematic inspection programme focuses on assessing physical and environmental restraint, as well as other forms of restrictive practices being implemented within a service.

In April, HIQA released an updated set of guidance documents to assist registered providers and staff of designated centres for older people on quality improvement in the area of restrictive practice. HIQA have recommended that services utilise the guidance:

• to promote a care environment that is free from restrictive practice,
• to assess the use of restrictive practices in their centres with a view to reducing or eliminating their use, or
• on ensuring the safety and wellbeing of residents in cases where restrictive practices are assessed as being necessary.

Restrictive Practices Guidance Documents

The guidance documentation set includes:

• “Guidance on promoting a care environment that is free from restrictive practice” – This document can be utilised by the residential home to assess its use of restrictive practices with a view to reducing or eliminating their use. In cases where restrictive practices are assessed as being necessary, this document provides guidance on ensuring the safety and wellbeing of residents.
• “Self-assessment Questionnaire Restrictive Practice Thematic Programme” – This is provided as an editable pdf document to aid providers in their preparation for the restrictive practice thematic programme. The document lists a series of questions relating to the standards and, based on the responses, requires the Provider to make a judgement on the residential home’s compliance level.
• “Quality Improvement Plan” – This template document provides an opportunity for the Provider to identify and target areas for improvement in relation to use of restrictive practice within the service.
• “Assessment Judgment Framework for Thematic Inspections of Restrictive Practices Older People’s Services”– This document supports the Provider and staff to review their own services. The framework details the lines of enquiry that will be explored by inspectors in order to assess the service’s performance against the standards being monitored.

The documents are available to download from HIQA’s website here: https://www.hiqa.ie/reports-and-publications/guide/guidance-restrictive-practice-dcop.

Restrictive Practices Compliance

In order to ensure compliance in relation to the management of restrictive practice, the residential home must ensure the following are in place:

• Governance – The residential home must ensure appropriate governance arrangements are in place to ensure the rights of residents to live in an environment which is restraint-free is upheld and activity promoted. This shall include the implementation of a Restrictive Practice Committee to assess the need for restraint and ensuring that the Management Team monitor the use of restrictive practices and work to eliminate their use as part of the care provision. The individual roles and responsibilities of the Registered Provider, Person in Charge and all staff in relation to the management of restrictive practice must be documented and communicated. The residential home’s Statement of Purpose must outline the specific care needs that the service can provide and only admits residents that can be appropriately cared for and supported in line with their needs and preferences.
• Policy and Procedure on the Management of Restrictive Practices – A comprehensive policy and procedure on the management of restrictive practices must be implemented and reflective of National Policy, relevant regulations and guidance. The restrictive practices procedure must provide clarity on the following:
  • Processes to reduce the need for restrictive practice
  • Contraindications for the Use of Restrictive Practice
  • Circumstances when a restrictive practice is permitted in a time limited way
  • Process for restraint assessment and care implementation
  • Requirements for informed consent.
  • Restraint in emergency situations
  • Restrictive practice reporting
• Informed Consent – The service must ensure that the will and preference of residents during the provision of care is respected and shall work on the presumption that all adults have a capacity to make choices about their own care. The residential home must consult with residents and seek their informed consent, prior to any use of restrictive practices. Obtaining consent must be reflective of the Assisted Decision Making (Capacity) Act 2015, and where the resident requires additional support in decisions relating to the use of restraint, they must be facilitated to access independent advocacy services as reflected in HIQA’s newly released Resources on the Fundamentals of Advocacy in health and social care (2023).
• Resources – The residential home must ensure the appropriate resources, such as staffing, are in place to support residents and ensure their rights are protected.
• Monitoring, Analysis and Learnings arising from the use of Restrictive Practices – The governance arrangements in place must ensure that the use of restrictive practices is effectively monitored on an ongoing basis, both via the Restrictive Practice Committee and the Management Team. All individual episodes of restraint must be reviewed to ensure that any learning arising from the incident are identified, as well as an overall review of the service’s approach being completed as part of the annual review of the quality of care provided.

How can HCI help?

Policies and Procedures

HCI has developed a set of care documents for the Management of Restrictive Practices in nursing homes based on the best practice guidance. These documents are available on HCICareTools.com and include:

• Management of Restrictive Practices Policy and Procedure
• Restraint Assessment Form
• Restraint Register

Restrictive Practices Audit

HCI has significant experience in conducting Quality of Care Audits in nursing homes. We can conduct a Restrictive Practices audit at your nursing home to assess your compliance with the guidance and identify any potential areas for improvement. This will allow you to put the necessary Quality Improvement Plans (QIPs) in place and be prepared for a HIQA Thematic Inspection of Restrictive Practices.

For more information on how HCI can support you contact info@hci.care or call +353 (0)1 629 2559.

References

Health Information and Quality Authority (2023). Guidance on Promoting a Care Environment that is Free from Restrictive Practice. Cork: Health Information and Quality Authority.

Health Information and Quality Authority (2023b). Self-Assessment Questionnaire – Restrictive Practice Thematic Programme. Cork: Health Information and Quality Authority.

Health Information and Quality Authority (2023c). Restrictive Practice Thematic Programme Quality Improvement Plan. Cork: Health Information and Quality Authority.

Health Information and Quality Authority (2023d). Assessment Judgement Framework for Thematic Inspections of Restrictive Practices. Cork: Health Information and Quality Authority.