Minimising restrictive practices in health care

Restrictive practices are potentially harmful non-therapeutic interventions, and their use can be avoided by positive changes to the provision of assessment, treatment, care and support.

The use of restrictive practices must therefore be a last resort, and only used after alternative strategies have failed or there is imminent or actual health or safety risk. In these situations, workers with expertise will apply and monitor, and support recovery afterwards, in order to reduce harm.

SA Health policy and supporting documents

The Minimising Restrictive Practices in Public Health Care Services Policy (PDF 555KB) offers mandatory guidance to clinicians concerning the minimisation, initiation, removal, reporting, and recovery of all instances involving restrictive practices. It highlights the core principles of minimising restrictive practices which includes:

  • restrictive practices are only initiated as a last resort
  • patient welfare, dignity, human rights, decision-making capacity, and cultural considerations are always considered prior to initiating restrictive practices
  • restrictive practices are only initiated to the extent that is reasonably necessary, when all alternative strategies have failed and in the least restrictive manner possible
  • patients, families, carers, workers, and other people are guided through recovery throughout and on cessation of the restrictive practice.

Minimising Restrictive Practice Clinical Guideline

The Minimising Restrictive Practices Clinical Guideline (PDF 404KB) supports SA Health services to act on the mandatory requirements outlined within the Minimising Restrictive Practices in Public Health Care Services Policy (PDF 555KB). It aims to facilitate minimising, or eliminating where possible, the use of restrictive practices to ensure patients are provided with the highest quality of care in accordance with their human rights and decision-making capacity.

Minimising Restrictive Practice Tool

The Clinical Scenarios: When is it restraint? (PDF 417KB) presents a series of clinical scenarios designed to assist clinicians in understanding the nuances of restraint application in different patient situations. Each scenario emphasises the unique nature of patient care, recognising that individual circumstances and clinician judgment play significant roles in decision-making.

RESTRICT Reflective Practice Tool

The RESTRICT Reflective Practice Tool (PDF 161KB) supports healthcare professionals to critically reflect on the use of restrictive practices. Structured around key principles such as Rights, Empathy, Safety and Compassion, this tool encourgaes staff to consider person centred alternatives and supports learning through debriefing and professional discussions.

Restrictive Practices Consumer Fact Sheet

The Restrictive Practices Consumer Fact Sheet (PDF 302KB) provides clear, accessible information for patients, families and carers about what restrictive practices are, when and why they must be used, and the rights of those receiving care. It outlines what SA Health services do to minimise restrictive practices and how patients are supported if these practices are used. It also includes contact information for feedback and concerns.

2024 revision of the minimising restrictive practices documents

SA Health revised the suite of minimising restrictive practices documents in 2024. The revised documents build upon the foundational values of the originals, emphasising the prevention and reduction of the use of restrictive practices. They expand on these principles with a focus on vulnerable groups, providing additional clarity to clinicians on when they can and cannot apply restrictive practices and how to do so safely.

National Safety and Quality Service Standard 5: Comprehensive Care

The NSQHS Standard 5: Comprehensive Care describes actions that need to be met for accreditation:

5.35 Where restraint is clinically necessary to prevent harm, the health service organisation has systems that:

  • minimise and, where possible, eliminate the use of restraint
  • govern the use of restraint in accordance with legislation
  • report use of restraint to the governing body

5.36 Where seclusion is clinically necessary to prevent harm and is permitted under legislation, the health service organisation has systems that:

  • minimise and, where possible, eliminate the use of seclusion
  • govern the use of seclusion in accordance with legislation
  • report use of seclusion to the governing body

The SA Health Accreditation Resource Standard 5: Comprehensive Care identifies the resources that are available to support each action.

Contact

Safety and Quality
Email:  Health.DHWClinicalGovernanceEnquiries@sa.gov.au