Audit Tool for the use of Mechanical Means of Bodily Restraint in Mental Health Services

Unit Name:

Objective of Audit tool:

This audit tool is to be used to retrospectively audit the use of Mechanical Means of Bodily Restraint in Mental Health Services and to identify if the processes used are in line with the Mental Health Commission Rules Governing the use of Mechanical restraint and Mechanical Means of Bodily Restraint (October 2009)

Methodology:

Inclusion Criteria: All residents who were subject to the use of mechanical means of bodily restraint

Frequency of Audit: Two options:(Note: this is example only, frequency to be agreed by the MDT Team)

1. Monthly: All care plans for residents were subject to the use of mechanical means of bodily restraintduring the previous months are retrospectively audited at one time.

2.On anongoing basis: This audit tool may be completed after the individual resident’s episode of restraint

Method:This is a retrospective care plan audit

Ward / Date of Audit
Auditor(s) Name(s) / Auditor(s) Title (s)
Resident Identifier (name/ Hospital Number) / 1. / 2. / 3.
4. / 5. / 6.

Methodology: Please insert 1 for Yes, if the item is found in the resident’s care record. Record 0 for No, the item is not present or

N/A (Not applicable)

Audit Tool for the used of Mechanical restraint in Mental Health services

Unit Name:

Section A: Initiation of Mechanical Restraint

A / Is there evidence that: / 1 / 2 / 3 / 4 / 5 / 6
A1 / The mechanical restraint of the patient was initiated by a registered medical practitioner and/ or a registered nurse
A2 / This decision is recorded in the patient’s clinical file
A3 / This decision is recorded on the Register for Mechanical Means of Bodily Restraint
A4 / The consultant psychiatrist is notified about the mechanical restraint by the medical practitioner and/ or the nurse practitioner
A5 / The notification of the consultant psychiatrist is recorded in the patient’s clinical file
A6 / There is evidence that alternatives to the use of mechanical means of bodily restraint were implemented prior to ordering mechanical means of bodily restraint
If the mechanical restraint was initiated by a registered nurse
A7 / An assessment of the patient was carried out prior to the initiation of mechanical restraint
A8 / This assessment included a risk assessment
A9 / A medical review tool place within 4 hours of commencing mechanical restraint
A10 / If mechanical restraint was continued following the medical review the order to continue was made by the medical practitioner and recorded in the patient’s clinical file and on the Register for Mechanical Means of Bodily Restraint
A11 / The order to continue mechanical restraint included details of the planned duration of the mechanical restraint
A12 / The duration of the mechanical restraint is no longer than 8 hours from the time of commencement of the mechanical restraint
If the mechanical restraint was initiated by a medical practitioner
A13 / An assessment of the patient was carried out prior to the initiation of mechanical restraint
A15 / This assessment included a risk assessment
A16 / The order to continue mechanical restraint included details of the duration of the mechanical restraint
A17 / The duration of the mechanical restraint is no longer than 8 hours from the time of commencement of the mechanical restraint
A18 / The order to continue mechanical restraint included details of the duration of the mechanical restraint,
Total Scores for Yes
Total Scores for No
Total Scores for N/A
% Total = Total Scores for Yes X 100
Total = 18(Total – N/A)

Comment: ______

______

______

Section B: Post initiation of Mechanical Restraint

B / Is there evidence that: / 1 / 2 / 3 / 4 / 5 / 6
B1 / The Register for Mechanical Means of Bodily Restraint is signed by the consultant psychiatrist responsible for the care and treatment or the duty consultant psychiatrist within 24 hours of initiating the mechanical restraint
B2 / The patient was informed of the reasons, likely duration of and the circumstances which will lead to the discontinuation of mechanical restraint
B3 / The patient was not informed of the reasons, likely duration of and the circumstances which will lead to the discontinuation of mechanical restraint as it was prejudicial to the patient’s mental health, well-being or emotional condition and this decision is recorded in the patient’s clinical file.
B4 / Where patient has capacity, patient consent was obtained to inform the patient’s next of kin of the mechanical restraint
B5 / Where consent was obtained, the patient’s next of kin or representative was informed of the patient’s mechanical restraint
B6 / Where the capacitated patient did not give consent, the next of kin was not contacted
B7 / Communication/ non-communication to next of kin in relation to the episode of mechanical restraint was recorded in the patient’s clinical file
B8 / Reasons for non communication of the mechanical restraint to the patient’s next of kin are recorded on the patient’s clinical file
Total Scores for Yes
Total Scores for No
Total Scores for N/A
% Total = Total Scores for Yes X 100
Total = 8(Total – N/A)

Comment: ______

______

Section C: Patient Dignity and Safety

C / Is there evidence that: / 1 / 2 / 3 / 4 / 5 / 6
C1 / There is evidence that alternatives to mechanical means of bodily restraint were considered prior to commencing mechanical restraint
C2 / There is evidence that any specific requirements/ needs of the patient in relation to the mechanical means of bodily restraint (including any “advance directives”) were considered
C3 / There is evidence that prior to using mechanical means of bodily restraint that special consideration was given to a patient who is known to have experienced physical or sexual abuse
C4 / There is evidence of medical and/or nursing staff continuously assessing the patient throughout the use of mechanical restraint
Total Scores for Yes
Total Scores for No
Total Scores for N/A
% Total = Total Scores for Yes X 100
Total = 4(Total – N/A)

Comment: ______

______

______

Section D: Management of a Patient during mechanical restraint

D / Is there evidence that: / 1 / 2 / 3 / 4 / 5 / 6
D1 / The use of the mechanical restraint is clearly recorded in the patient’s clinical file
D2 / The use of the mechanical restraint is clearly recorded in the Register for Mechanical Means of Bodily Restraint and is present in the patient’s file
D3 / The multidisciplinary team developed a plan of care for the mechanically restrained patient
D4 / The plan of care details the monitoring and assessment processes to be followed
D5 / The plan of care details efforts to reduce the use of restraint for the patient
D6 / Where the mechanical restraint is used for longer than one month, it was subject to an independent review by a registered medical practitioner who was not directly involved in the patients care and treatment.
D7 / The patient’s individual care and treatment plan demonstrates that the assessed needs of the patient were addressed to achieve the goal of bringing the use of mechanical means of bodily restraint to an end.
Total Scores for Yes
Total Scores for No
Total Scores for N/A
% Total = Total Scores for Yes X 100
Total = 7(Total – N/A)

Comment: ______

______

Section E: Clinical Governance

E / Is there evidence that: / 1 / 2 / 3 / 4 / 5 / 6
E1 / The episode of mechanical means of bodily restraint was reviewed by members of the Multidisciplinary Team within 2 days of the episode of restraint
E2 / Where the mechanical restraint is used for longer than one month, it was subject to an independent review by a registered medical practitioner who was not directly involved in the patients care and treatment.
E3 / Quarterly reviews of all cases of mechanical means of bodily restraint must take place at least on a quarterly basis.
Total Scores for Yes
Total Scores for No
Total Scores for N/A
% Total = Total Scores for Yes X 100
Total = 3(Total – N/A)

Comment: ______

______

Section F: Mechanical Means of Bodily Restraint - Audit Outcomes

Unit Name: ______Date: ______

Audit Results / 1 / 2 / 3 / 4 / 5 / 6
% Total Compliance / % Total Compliance / % Total Compliance / % Total Compliance / % Total Compliance / % Total Compliance
Section A
Section B
Section C
Section D
Section E
Audit Outcomes / 1 / 2 / 3 / 4 / 5 / 6
Yes / No / Yes / No / Yes / No / Yes / No / Yes / No / Yes / No
Care Plan processes were appropriately applied at all times
There were deviations from the correct Care Plan processes
Recommendations for improvement are required
Recommendations arising from the audit: / Date for completion / Responsibility
Resident 1
Resident 2
Resident 3
Resident 4
Resident 5
Resident 6

Auditor Signature: ______Date:______

CNM Signature:______Date:______

Director of Nursing Signature: ______Date: ______

Audit Tool for the Use of Mechanical Means of Bodily Restraint in Mental Health QPS DML, Sept 14, Page 1 of 7