An Update to Our Position on Reducing Restrictive Practice
In this blog, Rebecca Bauers, Director for people with a learning disability and autistic people, discusses our continuing work reducing restrictive practice and in particular reducing the use of intubation.
Last year we published our policy position on reducing restrictive practice. Since then, we have become increasingly concerned about the use of chemical restraint, in particular the use of intubation.
Intubation is a standard procedure that involves passing a tube into a person’s airway. This procedure is often performed before surgery or in emergencies to give medication or help a person breathe. Most people recover from intubation with no long-term effects. However, like any procedure, it does have some risks. We have noticed through our regulatory work that this practice has been used to control autistic people and people with a learning disability when they are communicating distress in hospital settings. The outcome for people as a result of this practice has and can be devastating.
From the information we receive we know that autistic people and people with a learning disability are too often subject to various forms of restrictive practice. Our review of incidents has shown the impact on people can be detrimental and life changing. This is not acceptable. Chemical restraint impacts autonomy, choice, dignity, and respect for a person, and for this reason, could be a breach of people’s human rights.
We are especially concerned about incidents in acute settings, of prolonged use and/or use of the most highly sedating options of chemical restraint, leading to unconscious sedation and intubation of autistic people and people with a learning disability of all ages, including children. When autistic people and people with a learning disability go to hospital, they are too often faced with unnecessary barriers caused by a lack of reasonable adjustments, poor communication, and a workforce without the skills to meet their needs.
We are aware of cases where children, young people and adults have been intubated when they have become acutely distressed, and we know that for everyone involved — including staff — this has been a traumatic experience. The most extreme chemical restraint occurs when a person is sedated to the point of unconsciousness through anaesthetic medicines and their breathing is controlled by the mechanical means of a ventilator. Other forms of chemical restraint can include the administration of sedation which affects a person’s level of consciousness to “manage” how they are communicating their distress.
Chemical restraint is inappropriate when it could have been prevented through better person-centred planning, listening, understanding, skills, support, and system partner collaboration. People must not be unnecessarily sedated, rapidly tranquillised or anaesthetised for communicating an unmet need, emotions, or distress.
What good looks like under our new approach
In all services we expect care to be person-centred. We expect providers to promote positive cultures that support recovery, build trust between people and staff, and protect the safety and wellbeing of all patients and people using services.
We know that ensuring all staff are trained appropriately, offering person-centred planning and support, and learning in safety cultures promote quicker de-escalation, and reduce or avoid the need for chemical restraint. Organisations must have mechanisms for monitoring the use of chemical restraint to drive its reduction.
Wherever we see chemical restraint being used we will want to understand why and how the decisions have been made about this course of action. If such evidence is not available or we believe a person’s human rights have been impacted by inappropriate chemical restraint, we will take action.
Where we see the use of chemical restraint could have been avoided, we will take action to keep people safe. As part of developing our new approach we are talking with providers and people who use services about what good looks like.
Our next steps
Through our regulatory approach, we will continue to raise awareness and understanding of the issues surrounding chemical restraint.
We have provided guidance to support our inspectors to support our commitment to improving how we respond when we are made aware of the use of chemical restraint.
Using our new approach we can identify failings in a person’s pathway, take action to drive improvement, promote good practice and ultimately good outcomes for people.
We will also publish information externally to raise awareness of the inappropriate use of chemical restraint and drive better, less harmful, person-centred care.
Finally, we all have a responsibility to stand up for and promote people’s right to safe and appropriate care and treatment. With that in mind what will you do to raise awareness of this issue and help us get to a place where the use of chemical restraint is rare?
