Restraint practices in Australasian emergency departments

The objective of this study was to estimate the use of restraint techniques and evaluate restraint policies and training in Australasian emergency departments

A survey of 116 Australasian emergency departments was conducted to determine the type, indications/contraindications, training, policies, documentation and audit requirements for restraint.

The overall estimated rate of patient restraint is 3.3 episodes per 1000 presentations. The commonest indications for restraint are violence or threatened violence (52%), psychosis (32%) and acute brain syndrome (10%). Major contraindications are medical instability, risk of harm to staff in applying restraint and the availability of alternatives to restraint. Chemical restraint is used in all emergency departments surveyed. The commonest agents used are haloperidol (93%), midazolam (82%) and diazepam (59%). At least one benzodiazepine and one major tranquilliser are used in 97% of emergency departments. Manual restraint (87%) is frequently used as a prelude to chemical or, less frequently, mechanical restraint (69%). Seclusion restraint is used in 23% of Australasian emergency departments. Formal training is most commonly undertaken for chemical restraint, being used in 33% of departments surveyed. Less than half of the departments have written policies guiding the use of restraint, and only 11% audit their use of restraint. A specific form for restraint documentation is used in only one emergency department.

Patient restraint is a common procedure in Australasian emergency departments. There is little formal training in, or documentation or audit of, restraint practices in Australasian emergency departments, despite the important clinical, occupational health and medical legal issues associated with the use of restraint.