SUBMISSION TO
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SUBMISSION TO STANDING COMMITTEE LEGISLATIVE ASSEMBLY
FromCANADIAN PENSIONERS CONCERNED, INC., ONTARIO DIVISION
RE BILL 135
AN ACT TO AMEND THE PUBLIC HOSPITALS ACT
TO REGULATE THE
USE OF RESTRAINTS THAT ARE NOT PART OF MEDICAL TREATMENT
FEBRUARY 7, 2001. Prepared by: MAE HARMAN
Bill 135
Canadian Pensioners Concerned, Ontario Division, is pleased to endorse the proposed
bill to regulate the use of restraints that are not part of medical treatment. We support
the principles that restraints be used:
- Only when necessary to protect the patient or others from serious bodily injury.
- Only when consent to their use has been given by the patient or by the patient's
substitute
decision-maker.
- Only when a written order has been given by a physician.
(An exception to the above requirements for restraint use to be provided for situations
when
immediate action is necessary to prevent serious bodily injury to the patient or to
others.)
A physician's written order shall specify what type of restraint is to be used.
Restraints must be designed not to cause physical injury and the least amount of
discomfort.
Restraints may only be applied by staff who have received training on restraint use
and
alternatives.
Restraints may not be applied for longer than two hours unless a physician
reassesses
the need and gives a written order.
Restrained patients must be monitored at least every fifteen minutes.
Staff must change the position of a restrained patient every hour.
Every use of a restraint must be documented in the patient's chart (including
those
restraints applied in an emergency) with the following information:
- The type of restraint used.
- The date, the time and the length of time the restraint is used.
- The types of less restrictive restraints considered by the physician and the reasons
they were
not specified in the order.
- Information on treatment planning designed to reduce the need to use a restraint.
When restraints are applied in an emergency without a patient's consent the
hospital must
disclose the information regarding the restraint use to the patient or the substitute
decision-maker.
Restraints may not be used to replace personal attention, to punish a patient, or
for the
convenience of the hospital staff.
Every hospital shall establish written policies and procedures governing the
use of
restraints to comply with the bill.
These policies and procedures shall be provided to patients upon their admission
to the
hospital and shall be posted in patient rooms.
Restraints are Being Used
Research has shown that restraints are being experienced by up to 33% of patients
in hospitals
in Ontario, as compared to roughly 17% in the USA. In Ontario there is legislation for
use of
restraints in our nursing homes, charitable institutions and homes for the aged and
there is a
residents' bill of rights, and the Mental Health Act provides guidelines for restraint use
in
psychiatric institutions. However, it is left to individual hospitals and administrators to
decide
what policies and procedures will be used. Clearly there is need for legislation
which
applies to hospitals.
What Do Restraints Accomplish?
There is no clear evidence that indiscriminate use of restraints is helpful to patients.
They tend to
create more problems. Patients are admitted to hospital for health care, to alleviate
pain and
discomfort, and hopefully to help them recover their health. Patients deserve to
be treated
with respect and dignity. Older patients are often suffering from confusion and find it
difficult to
express their needs. Being restrained adds to their confusion , their fear and their
sense of
abandonment, and strips them of their dignity and freedom. This does nothing to
facilitate
either their physical or psychological recovery.
One of the reasons cited for use of restraints is a lack of staff to deal adequately
with the needs
of those patients who are confused and upset. This is a terrible reflection on our
health care in
general and implies that appropriate health care on all levels is in jeopardy. If we
do not have
adequate funding of hospital services to provide adequate staff coverage, what other
parts of
care are delayed or neglected? How much does such inadequate treatment
contribute to
increased costs as patients fail to progress or have to be followed up with home
care (for
which there is not adequate staffing and funding) or repeat admissions to
hospital?
Appropriate staffing and the necessary funding must be put in place to provide
adequate
staffing of our hospitals along with the other levels of quality care.
Patients are sometimes subjected to restraints because staff feel under pressure
and restrain
patients because they don’t feel they have time to deal with them, or as punishment
for
repeated demands for assistance. This behaviour is just not acceptable. All staff who
work with
patients must be committed to respect patients and their right of choice over their own
care,
consideration for their dignity and respect for their individual needs and values. They
must be
trained on the use of restraints and alternatives. The greater use of full time nurses
would
provide greater consistency of care. They must have adequate time in their schedules
and
workloads to adequately serve their patients.
Conclusion
As seniors, whose need for health care increases as we age, we are deeply worried by
the
present inadequacies of health care in Ontario -- cuts in staffing, waiting periods,
deterioration
of care, sending patients home from hospital sicker and quicker than ever before
without
adequate arrangements for alternate care, overcrowding of emergency services,
shortage of
nursing home placements, high costs of some prescribed drugs not on the Pharmacare
list, etc.
There is no reason why this prosperous province cannot provide a good quality of
health care for all ages and stages on a continuum including:
- health education;
- prevention of illness;
- primary care;
- hospital care;
- home and community care;
- institutions
.
The payoff in healthy citizens would be tremendous both for the economy and for a
harmonious
community.
We look to our provincial government to take immediate steps to deal both with the
restraint
question and adequate funding and staffing of our health system.
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