Restraint Practices in Incapable Wandering Patients During COVID-19: Ethics and Best Practice Recommendations

Area of Science:

• Gerontology
• Infectious Disease Epidemiology
• Bioethics

Background:

• Dementia patients exhibiting wandering behavior struggle with Infection Prevention and Control (IPC) measures, increasing COVID-19 transmission risk.
• Physical and chemical restraints are sometimes used for wandering patients, but are not standard care and raise ethical concerns.
• Existing provincial policies on restraint use lack context-specific guidance for individual patient care decisions.

Purpose of the Study:

• To address the knowledge gap regarding the management of wandering dementia patients during the COVID-19 pandemic.
• To develop an ethical framework for creating patient-centered care plans for incapable wandering patients at risk of COVID-19.
• To integrate medical, ethical, and legal considerations for managing wandering behavior and infection control.

Main Methods:

• An interdisciplinary review involving nurses, physicians, ethicists, hospital leadership, risk management, and legal counsel.
• Analysis of medical, ethical, and legal considerations surrounding restraint use and IPC for wandering patients.
• Development of a novel ethical framework for clinical decision-making.

Main Results:

• Identified significant challenges in applying IPC precautions for wandering dementia patients.
• Highlighted the ethical and legal complexities of using restraints in non-pandemic and pandemic scenarios.
• Established an ethical framework to guide the creation of balanced, patient-centered care plans.

Conclusions:

• Front-line healthcare workers require context-dependent ethical guidance for managing wandering dementia patients during infectious disease outbreaks.
• The proposed ethical framework supports individualized, patient-centered care that balances infection prevention with patient autonomy.
• Interdisciplinary collaboration is crucial for developing effective and ethical strategies for this vulnerable patient population.