Restraint practices in Australasian emergency departments

Objective: The objective of this study was to estimate the use of restraint techniques and evaluate restraint policies and training in Australasian em ergency departments Method: A survey of 116 Australasian emergency departments was conducted to determine the type, indications/contraindications, training, policies, doc umentation and audit requirements for restraint. Results: The overall estimated rate of patient restraint is 3.3 episodes pe r 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 i n applying restraint and the availability of alternatives to restraint. Che mical restraint is used in all emergency departments surveyed. The commones t agents used are haloperidol (93%), midazolam (82%) and diazepam (59%). At least one benzodiazepine and one major tranquilliser are used in 97% of em ergency departments. Manual restraint (87%) is frequently used as a prelude to chemical or, less frequently, mechanical restraint (69%). Seclusion res traint is used in 23% of Australasian emergency departments. Formal trainin g is most commonly undertaken for chemical restraint, being used in 33% of departments surveyed. Less than half of the departments have written polici es 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. Conclusions: Patient restraint is a common procedure in Australasian emerge ncy departments. There is little formal training in, or documentation or au dit of, restraint practices in Australasian emergency departments, despite the important clinical, occupational health and medical legal issues associ ated with the use of restraint.