Part 6: Restraint and seclusion

Section 6.1: A process of restraint

Criterion 6.1.1

Aged care: Guidance
  • The governance body’s strategic plan has an objective that:
    1. aims to eliminate restraint
    2. links to objectives operationalised in annual planning
    3. demonstrates commitment to implementing strategies to eliminate restraint
    4. includes quality improvement approaches
    5. demonstrates transparency of governance processes and links with the operational reviews.
Residential disability: Guidance
  • The governance body’s strategic plan has an objective that:
    1. aims to eliminate restraint
    2. links to objectives operationalised in annual planning
    3. demonstrates commitment to implementing strategies to eliminate restraint
    4. includes quality improvement approaches
    5. demonstrates transparency of governance processes and links with the operational reviews.
  • The governance body receives training on the intent of minimising restraint with the aim of eliminating it.
  • Service providers are committed to reducing inequities in the rate of restrictive practices that Māori and Pacific peoples experience when they access services.
  • Service providers consider environmental restraint and mitigation strategies.
Residential mental health and alcohol and other drug: Guidance
  • The governance body’s strategic plan has an objective that:
    1. aims to eliminate restraint
    2. links to objectives operationalised in annual planning
    3. demonstrates commitment to implementing strategies to eliminate restraint
    4. includes quality improvement approaches
    5. demonstrates transparency of governance processes and links with the operational reviews.
  • The governance body receives training on the intent of minimising restraint with the aim of eliminating it.
  • Service providers are committed to reducing inequities in the rate of restrictive practices that Māori and Pacific peoples experience when they access services.
  • Service providers consider environmental restraint and mitigation strategies.
Public/private hospital: Guidance
  • The governance body’s strategic plan has an objective that:
    1. aims to eliminate restraint
    2. links to objectives operationalised in annual planning
    3. demonstrates commitment to implementing strategies to eliminate restraint
    4. includes quality improvement approaches
    5. demonstrates transparency of governance processes and links with the operational reviews.
  • The governance body receives training on the intent of minimising restraint with the aim of eliminating it.
  • Service providers are committed to reducing inequities in the rate of restrictive practices that Māori and Pacific peoples experience when they access services.
  • Service providers consider environmental restraint and mitigation strategies.
Hospice: Guidance
  • The governance body’s strategic plan has an objective that:
    1. aims to eliminate restraint
    2. links to objectives operationalised in annual planning
    3. demonstrates commitment to implementing strategies to eliminate restraint
    4. includes quality improvement approaches
    5. demonstrates transparency of governance processes and links with the operational reviews.

Criterion 6.1.2

Residential disability: Guidance
  • Membership of the restraint oversight groups includes:
    1. Māori representation
    2. whānau representation.
  • Membership of the restraint oversight group includes lived experience of restrictive practice.
Residential mental health and alcohol and other drug: Guidance
  • Membership of the restraint oversight groups includes:
    1. Māori representation
    2. whānau representation.
  • Membership of the restraint oversight group includes lived experience of restrictive practice.
Public/private hospital: Guidance
  • Membership of the restraint oversight groups includes:
    1. Māori representation
    2. whānau representation.
  • Membership of the restraint oversight group includes lived experience of restrictive practice.

Criterion 6.1.3

Aged care: Guidance
  • Service providers may demonstrate they have an executive leader responsible for implementing and maintaining this commitment through their:
    1. organisational chart
    2. documented roles and responsibilities
    3. performance objectives.
  • Service providers implement this commitment with the intention of addressing inequity and improving Māori health outcomes.
  • Service providers implement this commitment with the intention of addressing equity and improvement health outcomes for people receiving services.
  • Service providers may have a restraint coordinator role or team with this responsibility.
Residential disability: Guidance
  • Service providers may demonstrate they have an executive leader responsible for implementing and maintaining this commitment through their:
    1. organisational chart
    2. documented roles and responsibilities
    3. performance objectives.
  • Service providers implement this commitment with the intention of addressing inequity and improving Māori health outcomes.
  • Service providers implement this commitment with the intention of addressing equity and improvement health outcomes for people receiving services.
  • Service providers may have a restraint coordinator role or team with this responsibility.
Residential mental health and alcohol and other drug: Guidance
  • Service providers may demonstrate they have an executive leader responsible for implementing and maintaining this commitment through their:
    1. organisational chart
    2. documented roles and responsibilities
    3. performance objectives.
  • Service providers implement this commitment with the intention of addressing inequity and improving Māori health outcomes.
  • Service providers implement this commitment with the intention of addressing equity and improvement health outcomes for people receiving services.
  • Service providers may have a restraint coordinator role or team with this responsibility.
Public/private hospital: Guidance
  • Service providers may demonstrate they have an executive leader responsible for implementing and maintaining this commitment through their:
    1. organisational chart
    2. documented roles and responsibilities
    3. performance objectives.
  • Service providers implement this commitment with the intention of addressing inequity and improving Māori health outcomes.
  • Service providers implement this commitment with the intention of addressing equity and improvement health outcomes for people receiving services.
  • Service providers may have a restraint coordinator role or team with this responsibility.
Hospice: Guidance
  • Service providers may demonstrate they have an executive leader responsible for implementing and maintaining this commitment through their:
    1. organisational chart
    2. documented roles and responsibilities
    3. performance objectives.
  • Service providers implement this commitment with the intention of addressing inequity and improving Māori health outcomes.
  • Service providers implement this commitment with the intention of addressing equity and improvement health outcomes for people receiving services.
  • Service providers may have a restraint coordinator role or team with this responsibility.

Criterion 6.1.4

Aged care: Guidance
  • Operating policy determines, defines and integrates indicators relating to restraint.
  • Service providers monitor environmental impacts on the use of restraint and implement changes that contribute to restraint minimisation.
  • Service providers have reporting systems in place to identify trends in restraint use, including trends and strategies to minimise restraint.
Residential disability: Guidance
  • Operating policy determines, defines and integrates indicators relating to restraint.
  • Service providers monitor environmental impacts on the use of restraint and implement changes that contribute to restraint minimisation.
  • Service providers have reporting systems in place to identify trends in restraint use, including trends and strategies to minimise restraint.
  • The reporting includes workforce data, such as:
    1. incidents related to health care and support worker injury
    2.  workforce wellbeing surveys
    3. ACC claims
    4. outcomes use data, which is used to profile the environment during an event
    5. use of the employee assistance programme by health care and support workers.
  • Service providers allocate resources to address actions that minimise restrictive practices, which may include:
    1. whakawhanaungatanga
    2. karakia
    3. waiata
    4. kai
    5. duress alarms
    6. sensory rooms
    7. designing units well with good lighting, space, and access to outside areas
    8. creating a more welcoming environment for Māori, such as by displaying cultural whakataukī or Māori proverbs, Māori carvings, or pictures
    9. occupational therapists
    10. activity programmes
    11. de-escalation training and other skills training for health care and support workers, such as brief psychotherapeutic interventions.
  • Service providers refer to Te Pou ‘The Six Core Strategies service review tool’.
Residential mental health and alcohol and other drug: Guidance
  • Operating policy determines, defines and integrates indicators relating to restraint.
  • Service providers monitor environmental impacts on the use of restraint and implement changes that contribute to restraint minimisation.
  • Service providers have reporting systems in place to identify trends in restraint use, including trends and strategies to minimise restraint.
  • The reporting includes workforce data, such as:
    1. incidents related to health care and support worker injury
    2.  workforce wellbeing surveys
    3. ACC claims
    4. outcomes use data, which is used to profile the environment during an event
    5. use of the employee assistance programme by health care and support workers.
  • Service providers allocate resources to address actions that minimise restrictive practices, which may include:
    1. whakawhanaungatanga
    2. karakia
    3. waiata
    4. kai
    5. duress alarms
    6. sensory rooms
    7. designing units well with good lighting, space, and access to outside areas
    8. creating a more welcoming environment for Māori, such as by displaying cultural whakataukī or Māori proverbs, Māori carvings, or pictures
    9. occupational therapists
    10. activity programmes
    11. de-escalation training and other skills training for health care and support workers, such as brief psychotherapeutic interventions.
  • Service providers refer to Te Pou ‘The Six Core Strategies service review tool’.
Public/private hospital: Guidance
  • Operating policy determines, defines and integrates indicators relating to restraint.
  • Service providers monitor environmental impacts on the use of restraint and implement changes that contribute to restraint minimisation.
  • Service providers have reporting systems in place to identify trends in restraint use, including trends and strategies to minimise restraint.
  • The reporting includes workforce data, such as:
    1. incidents related to health care and support worker injury
    2.  workforce wellbeing surveys
    3. ACC claims
    4. outcomes use data, which is used to profile the environment during an event
    5. use of the employee assistance programme by health care and support workers.
  • Service providers allocate resources to address actions that minimise restrictive practices, which may include:
    1. whakawhanaungatanga
    2. karakia
    3. waiata
    4. kai
    5. duress alarms
    6. sensory rooms
    7. designing units well with good lighting, space, and access to outside areas
    8. creating a more welcoming environment for Māori, such as by displaying cultural whakataukī or Māori proverbs, Māori carvings, or pictures
    9. occupational therapists
    10. activity programmes
    11. de-escalation training and other skills training for health care and support workers, such as brief psychotherapeutic interventions.
  • Service providers refer to Te Pou ‘The Six Core Strategies service review tool’.
Hospice: Guidance
  • Operating policy determines, defines and integrates indicators relating to restraint.
  • Service providers monitor environmental impacts on the use of restraint and implement changes that contribute to restraint minimisation.
  • Service providers have reporting systems in place to identify trends in restraint use, including trends and strategies to minimise restraint.

Criterion 6.1.5

Aged care: Guidance
  • The executive leader:
    1. facilitates a restraint monitoring committee
    2. understands the different types of restraint used within their services
    3. approves and reviews restraint meeting minutes
    4. monitors progress towards meeting corrective actions in a timely manner
    5. verifies approval documents signed by registered health practitioner
    6. upskills health care and support workers on de-escalation strategies, effective communication, and cultural safety.
  • Service providers develop person-centred policies and procedures to support least-restrictive best practice that:
    1. meet the requirements of the criterion
    2. provide information about restraint to the person and their whānau in a manner they understand when they enter the service
    3. include holistic assessment processes of the person, support plan, and information on avoiding the use of restraint
    4. aim to make the environment as stress-free as possible.
  • As part of the holistic assessment, the person’s care or support plan may include:
    1. frequency and extent of monitoring
    2. cultural, physical, and verbal assessment processes
    3. personal, cultural, and belief systems
    4. strategies that align with trauma-informed care principles.
  • Service providers reject the inappropriate use of medication to make a person incapable of resistance or to force compliance. They show evidence of having non-medicating options such as talking with the person, addressing their concerns, and supporting the person with time for reflection.
Residential disability: Guidance
  • The executive leader:
    1. facilitates a restraint monitoring committee
    2. understands the different types of restraint used within their services
    3. approves and reviews restraint meeting minutes
    4. monitors progress towards meeting corrective actions in a timely manner
    5. verifies approval documents signed by registered health practitioner
    6. upskills health care and support workers on de-escalation strategies, effective communication, and cultural safety.
  • Service providers develop person-centred policies and procedures to support least-restrictive best practice that:
    1. meet the requirements of the criterion
    2. provide information about restraint to the person and their whānau in a manner they understand when they enter the service
    3. include holistic assessment processes of the person, support plan, and information on avoiding the use of restraint
    4. aim to make the environment as stress-free as possible.
  • As part of the holistic assessment, the person’s care or support plan may include:
    1. frequency and extent of monitoring
    2. cultural, physical, and verbal assessment processes
    3. personal, cultural, and belief systems
    4. strategies that align with trauma-informed care principles.
  • Service providers reject the inappropriate use of medication to make a person incapable of resistance or to force compliance. They show evidence of having non-medicating options such as talking with the person, addressing their concerns, and supporting the person with time for reflection.
  • Policies should include the governance body’s aim to eliminate restraint wherever possible, showing clear leadership around improved assessment and health care and support worker training.
  • Service providers demonstrate support that is culturally responsive. This may include instances where a cultural support worker guides the clinical team.
  • Service providers give information about de-escalation to the person receiving services and their whānau in a timely and accessible manner that they all understand. This includes information on the complaints process and the opportunity for an independent review into the use of restraint on a whānau member.
  • The service provider’s information pack for the person and their whānau about de-escalation may come in a variety of accessible formats and languages and may include any documented evidence the person receives, such as the admission checklist or their clinical record.
  • As part of the holistic assessment, the person’s care or support plan may include: 
    1. lessons from previous restraint, such as environmental triggers
    2. alternatives to restraint such as Māori cultural sensory support, other cultural interventions, or cultural support experts, including waiata, pūrākau, and karakia
    3. restraint minimisation actions, such as positive behaviour support strategies
    4. least-restrictive, person-centred, and whānau-centred approaches, such as sensory modulation and use of whānau and other relevant support people.
  • Service providers provide a timely debriefing for all parties involved in restraint, including:
    1. people who are restrained and their whānau
    2. people who witness the restraint
    3. health care and support workers who were involved.
  • Assessment and risk mitigation processes support the use of alternative interventions, which may include:
    1. use of sensory modulation resources
    2. diversional therapy
    3. mindfulness
    4. peer support approaches
    5. occupational therapy
    6. low beds
    7. specialling
    8. other therapeutic approaches.
  • Service providers provide access to alternative support options, including peer support, and these options are readily available with the aim of eliminating restraint.
Residential mental health and alcohol and other drug: Guidance
  • The executive leader:
    1. facilitates a restraint monitoring committee
    2. understands the different types of restraint used within their services
    3. approves and reviews restraint meeting minutes
    4. monitors progress towards meeting corrective actions in a timely manner
    5. verifies approval documents signed by registered health practitioner
    6. upskills health care and support workers on de-escalation strategies, effective communication, and cultural safety.
  • Service providers develop person-centred policies and procedures to support least-restrictive best practice that:
    1. meet the requirements of the criterion
    2. provide information about restraint to the person and their whānau in a manner they understand when they enter the service
    3. include holistic assessment processes of the person, support plan, and information on avoiding the use of restraint
    4. aim to make the environment as stress-free as possible.
  • As part of the holistic assessment, the person’s care or support plan may include:
    1. frequency and extent of monitoring
    2. cultural, physical, and verbal assessment processes
    3. personal, cultural, and belief systems
    4. strategies that align with trauma-informed care principles.
  • Service providers reject the inappropriate use of medication to make a person incapable of resistance or to force compliance. They show evidence of having non-medicating options such as talking with the person, addressing their concerns, and supporting the person with time for reflection.
  • Policies should include the governance body’s aim to eliminate restraint wherever possible, showing clear leadership around improved assessment and health care and support worker training.
  • Service providers demonstrate support that is culturally responsive. This may include instances where a cultural support worker guides the clinical team.
  • Service providers give information about de-escalation to the person receiving services and their whānau in a timely and accessible manner that they all understand. This includes information on the complaints process and the opportunity for an independent review into the use of restraint on a whānau member.
  • The service provider’s information pack for the person and their whānau about de-escalation may come in a variety of accessible formats and languages and may include any documented evidence the person receives, such as the admission checklist or their clinical record.
  • As part of the holistic assessment, the person’s care or support plan may include: 
    1. lessons from previous restraint, such as environmental triggers
    2. alternatives to restraint such as Māori cultural sensory support, other cultural interventions, or cultural support experts, including waiata, pūrākau, and karakia
    3. restraint minimisation actions, such as positive behaviour support strategies
    4. least-restrictive, person-centred, and whānau-centred approaches, such as sensory modulation and use of whānau and other relevant support people.
  • Service providers provide a timely debriefing for all parties involved in restraint, including:
    1. people who are restrained and their whānau
    2. people who witness the restraint
    3. health care and support workers who were involved.
  • Assessment and risk mitigation processes support the use of alternative interventions, which may include:
    1. use of sensory modulation resources
    2. diversional therapy
    3. mindfulness
    4. peer support approaches
    5. occupational therapy
    6. low beds
    7. specialling
    8. other therapeutic approaches.
  • Service providers provide access to alternative support options, including peer support, and these options are readily available with the aim of eliminating restraint.
Public/private hospital: Guidance
  • The executive leader:
    1. facilitates a restraint monitoring committee
    2. understands the different types of restraint used within their services
    3. approves and reviews restraint meeting minutes
    4. monitors progress towards meeting corrective actions in a timely manner
    5. verifies approval documents signed by registered health practitioner
    6. upskills health care and support workers on de-escalation strategies, effective communication, and cultural safety.
  • Service providers develop person-centred policies and procedures to support least-restrictive best practice that:
    1. meet the requirements of the criterion
    2. provide information about restraint to the person and their whānau in a manner they understand when they enter the service
    3. include holistic assessment processes of the person, support plan, and information on avoiding the use of restraint
    4. aim to make the environment as stress-free as possible.
  • As part of the holistic assessment, the person’s care or support plan may include:
    1. frequency and extent of monitoring
    2. cultural, physical, and verbal assessment processes
    3. personal, cultural, and belief systems
    4. strategies that align with trauma-informed care principles.
  • Service providers reject the inappropriate use of medication to make a person incapable of resistance or to force compliance. They show evidence of having non-medicating options such as talking with the person, addressing their concerns, and supporting the person with time for reflection.
  • Policies should include the governance body’s aim to eliminate restraint wherever possible, showing clear leadership around improved assessment and health care and support worker training.
  • Service providers demonstrate support that is culturally responsive. This may include instances where a cultural support worker guides the clinical team.
  • Service providers give information about de-escalation to the person receiving services and their whānau in a timely and accessible manner that they all understand. This includes information on the complaints process and the opportunity for an independent review into the use of restraint on a whānau member.
  • The service provider’s information pack for the person and their whānau about de-escalation may come in a variety of accessible formats and languages and may include any documented evidence the person receives, such as the admission checklist or their clinical record.
  • As part of the holistic assessment, the person’s care or support plan may include: 
    1. lessons from previous restraint, such as environmental triggers
    2. alternatives to restraint such as Māori cultural sensory support, other cultural interventions, or cultural support experts, including waiata, pūrākau, and karakia
    3. restraint minimisation actions, such as positive behaviour support strategies
    4. least-restrictive, person-centred, and whānau-centred approaches, such as sensory modulation and use of whānau and other relevant support people.
  • Service providers provide a timely debriefing for all parties involved in restraint, including:
    1. people who are restrained and their whānau
    2. people who witness the restraint
    3. health care and support workers who were involved.
  • Assessment and risk mitigation processes support the use of alternative interventions, which may include:
    1. use of sensory modulation resources
    2. diversional therapy
    3. mindfulness
    4. peer support approaches
    5. occupational therapy
    6. low beds
    7. specialling
    8. other therapeutic approaches.
  • Service providers provide access to alternative support options, including peer support, and these options are readily available with the aim of eliminating restraint.
Hospice: Guidance
  • The executive leader:
    1. facilitates a restraint monitoring committee
    2. understands the different types of restraint used within their services
    3. approves and reviews restraint meeting minutes
    4. monitors progress towards meeting corrective actions in a timely manner
    5. verifies approval documents signed by registered health practitioner
    6. upskills health care and support workers on de-escalation strategies, effective communication, and cultural safety.
  • Service providers develop person-centred policies and procedures to support least-restrictive best practice that:
    1. meet the requirements of the criterion
    2. provide information about restraint to the person and their whānau in a manner they understand when they enter the service
    3. include holistic assessment processes of the person, support plan, and information on avoiding the use of restraint
    4. aim to make the environment as stress-free as possible.
  • As part of the holistic assessment, the person’s care or support plan may include:
    1. frequency and extent of monitoring
    2. cultural, physical, and verbal assessment processes
    3. personal, cultural, and belief systems
    4. strategies that align with trauma-informed care principles.
  • Service providers reject the inappropriate use of medication to make a person incapable of resistance or to force compliance. They show evidence of having non-medicating options such as talking with the person, addressing their concerns, and supporting the person with time for reflection.

Criterion 6.1.6

Aged care: Guidance
  • Service providers’ annual training plan includes:
    1. access to internal and external training for health care and support workers
    2. records of attendance and completed training
    3. records of competencies in different types of restraint training
    4. principles of de-escalation techniques, alternative interventions, and effective communication, including waiting for Māori, Pacific, or other cultural or peer support to be present
    5. safe practice in the use of restraint within a culture of continuous learning and improvement.
  • Service providers support and enable health care and support workers to access training and supervision. Supervision includes both cultural and clinical supervision.
  • Training is available in accessible formats.
Home and community: Guidance
  • Service providers’ annual training plan includes:
    1. access to internal and external training for health care and support workers
    2. records of attendance and completed training
    3. records of competencies in different types of restraint training
    4. principles of de-escalation techniques, alternative interventions, and effective communication, including waiting for Māori, Pacific, or other cultural or peer support to be present
    5. safe practice in the use of restraint within a culture of continuous learning and improvement.
  • Service providers support and enable health care and support workers to access training and supervision. Supervision includes both cultural and clinical supervision.
  • Training is available in accessible formats.

Residential disability: Guidance
  • Service providers’ annual training plan includes:
    1. access to internal and external training for health care and support workers
    2. records of attendance and completed training
    3. records of competencies in different types of restraint training
    4. principles of de-escalation techniques, alternative interventions, and effective communication, including waiting for Māori, Pacific, or other cultural or peer support to be present
    5. safe practice in the use of restraint within a culture of continuous learning and improvement.
  • Service providers support and enable health care and support workers to access training and supervision. Supervision includes both cultural and clinical supervision.
  • Training is available in accessible formats.
  • Service providers have an annual training plan that includes:
    1. training that is delivered by people with lived experience of restrictive practice and their whānau
    2. involving tāngata whaikaha in the design and delivery of training
    3. training or support delivered by behaviour specialists
    4. consideration of conscious and unconscious bias
    5. how to use and introduce cultural sensory support options for Māori and other cultures.
Residential mental health and alcohol and other drug: Guidance
  • Service providers’ annual training plan includes:
    1. access to internal and external training for health care and support workers
    2. records of attendance and completed training
    3. records of competencies in different types of restraint training
    4. principles of de-escalation techniques, alternative interventions, and effective communication, including waiting for Māori, Pacific, or other cultural or peer support to be present
    5. safe practice in the use of restraint within a culture of continuous learning and improvement.
  • Service providers support and enable health care and support workers to access training and supervision. Supervision includes both cultural and clinical supervision.
  • Training is available in accessible formats.
  • Service providers have an annual training plan that includes:
    1. training that is delivered by people with lived experience of restrictive practice and their whānau
    2. involving tāngata whaikaha in the design and delivery of training
    3. training or support delivered by behaviour specialists
    4. consideration of conscious and unconscious bias
    5. how to use and introduce cultural sensory support options for Māori and other cultures.
Public/private hospital: Guidance
  • Service providers’ annual training plan includes:
    1. access to internal and external training for health care and support workers
    2. records of attendance and completed training
    3. records of competencies in different types of restraint training
    4. principles of de-escalation techniques, alternative interventions, and effective communication, including waiting for Māori, Pacific, or other cultural or peer support to be present
    5. safe practice in the use of restraint within a culture of continuous learning and improvement.
  • Service providers support and enable health care and support workers to access training and supervision. Supervision includes both cultural and clinical supervision.
  • Training is available in accessible formats.
  • Service providers have an annual training plan that includes:
    1. training that is delivered by people with lived experience of restrictive practice and their whānau
    2. involving tāngata whaikaha in the design and delivery of training
    3. training or support delivered by behaviour specialists
    4. consideration of conscious and unconscious bias
    5. how to use and introduce cultural sensory support options for Māori and other cultures.
Hospice: Guidance
  • Service providers’ annual training plan includes:
    1. access to internal and external training for health care and support workers
    2. records of attendance and completed training
    3. records of competencies in different types of restraint training
    4. principles of de-escalation techniques, alternative interventions, and effective communication, including waiting for Māori, Pacific, or other cultural or peer support to be present
    5. safe practice in the use of restraint within a culture of continuous learning and improvement.
  • Service providers support and enable health care and support workers to access training and supervision. Supervision includes both cultural and clinical supervision.
  • Training is available in accessible formats.

Section 6.2: Safe restraint

Criterion 6.2.1

Aged care: Guidance
  • Service providers seek multidisciplinary input to provide appropriate support. This support may include, for example, a registered nurse, general practitioner, occupational therapist, or diversional therapist.
  • Service providers have tried and documented all alternative interventions.
Residential disability: Guidance
  • Service providers seek multidisciplinary input to provide appropriate support. This support may include, for example. a registered nurse, general practitioner, occupational therapist, or diversional therapist.
  • Service providers have tried and documented all alternative interventions.
  • Multidisciplinary input determines the appropriate support, such as  cultural or psychological support, to provide to people receiving services.
  • Service providers explore alternatives, such as sensory modulation, as part of the assessment process.
  • Service providers make all efforts to support the person and understand them in the first instance, before considering any form of restraint. They only use restraint as a last resort, and document such instances.
  • Health care and support workers have read the information on each person they are working with, so they are aware of:
    1. any trauma history
    2. known strategies to support the person when they are experiencing distress. 
  • Service providers use Māori cultural support as an integral part of de-escalation strategies and policies. For example, in instances where Māori may be restrained, the service provider demonstrates it has made its best effort to have a Māori health care or support worker present. 
  • Service providers use peer, Pacific or other cultural support as an integral part of their de-escalation strategies and policies. For example, in instances where a person may be restrained, the service provider demonstrates it has made its best efforts to have a peer, Pacific or other cultural support worker present. 
Residential mental health and alcohol and other drug: Guidance
  • Service providers seek multidisciplinary input to provide appropriate support. This support may include, for example. a registered nurse, general practitioner, occupational therapist, or diversional therapist.
  • Service providers have tried and documented all alternative interventions.
  • Multidisciplinary input determines the appropriate support, such as  cultural or psychological support, to provide to people receiving services.
  • Service providers explore alternatives, such as sensory modulation, as part of the assessment process.
  • Service providers make all efforts to support the person and understand them in the first instance, before considering any form of restraint. They only use restraint as a last resort, and document such instances.
  • Health care and support workers have read the information on each person they are working with, so they are aware of:
    1. any trauma history
    2. known strategies to support the person when they are experiencing distress. 
  • Service providers use Māori cultural support as an integral part of de-escalation strategies and policies. For example, in instances where Māori may be restrained, the service provider demonstrates it has made its best effort to have a Māori health care or support worker present. 
  • Service providers use peer, Pacific or other cultural support as an integral part of their de-escalation strategies and policies. For example, in instances where a person may be restrained, the service provider demonstrates it has made its best efforts to have a peer, Pacific or other cultural support worker present. 
Public/private hospital: Guidance
  • Service providers seek multidisciplinary input to provide appropriate support. This support may include, for example. a registered nurse, general practitioner, occupational therapist, or diversional therapist.
  • Service providers have tried and documented all alternative interventions.
  • Multidisciplinary input determines the appropriate support, such as  cultural or psychological support, to provide to people receiving services.
  • Service providers explore alternatives, such as sensory modulation, as part of the assessment process.
  • Service providers make all efforts to support the person and understand them in the first instance, before considering any form of restraint. They only use restraint as a last resort, and document such instances.
  • Health care and support workers have read the information on each person they are working with, so they are aware of:
    1. any trauma history
    2. known strategies to support the person when they are experiencing distress. 
  • Service providers use Māori cultural support as an integral part of de-escalation strategies and policies. For example, in instances where Māori may be restrained, the service provider demonstrates it has made its best effort to have a Māori health care or support worker present. 
  • Service providers use peer, Pacific or other cultural support as an integral part of their de-escalation strategies and policies. For example, in instances where a person may be restrained, the service provider demonstrates it has made its best efforts to have a peer, Pacific or other cultural support worker present. 
Hospice: Guidance
  • Service providers seek multidisciplinary input to provide appropriate support. This support may include, for example. a registered nurse, general practitioner, occupational therapist, or diversional therapist.
  • Service providers have tried and documented all alternative interventions.
  • Multidisciplinary input determines the appropriate support, such as  cultural or psychological support, to provide to people receiving services.
  • Service providers explore alternatives, such as sensory modulation, as part of the assessment process.
  • Service providers make all efforts to support the person and understand them in the first instance, before considering any form of restraint. They only use restraint as a last resort, and document such instances.
  • Health care and support workers have read the information on each person they are working with, so they are aware of:
    1. any trauma history
    2. known strategies to support the person when they are experiencing distress. 
  • Service providers use Māori cultural support as an integral part of de-escalation strategies and policies. For example, in instances where Māori may be restrained, the service provider demonstrates it has made its best effort to have a Māori health care or support worker present. 
  • Service providers use peer, Pacific or other cultural support as an integral part of their de-escalation strategies and policies. For example, in instances where a person may be restrained, the service provider demonstrates it has made its best efforts to have a peer, Pacific or other cultural support worker present. 

Criteria 6.2.2

Aged care: Guidance
  • Service providers have an implemented process describing the frequency and extent of monitoring restraint that relates to identified risks, including trauma history.
  • Post-event documentation is evident.
Residential disability: Guidance
  • Service providers have an implemented process describing the frequency and extent of monitoring restraint that relates to identified risks, including trauma history.
  • Post-event documentation is evident.
Residential mental health and alcohol and other drug: Guidance
  • Service providers have an implemented process describing the frequency and extent of monitoring restraint that relates to identified risks, including trauma history.
  • Post-event documentation is evident.
Public/private hospital: Guidance
  • Service providers have an implemented process describing the frequency and extent of monitoring restraint that relates to identified risks, including trauma history.
  • Post-event documentation is evident.
Hospice: Guidance
  • Service providers have an implemented process describing the frequency and extent of monitoring restraint that relates to identified risks, including trauma history.
  • Post-event documentation is evident.

Criterion 6.2.3

Aged care: Guidance
  • Service providers meet all needs, including needs for: 
    1. food and fluids
    2. hygiene 
    3. elimination 
    4. toilet
    5. repositioning and mobilising.
Residential disability: Guidance
  • Service providers meet all needs, including needs for: 
    1. food and fluids
    2. hygiene 
    3. elimination 
    4. toilet
    5. repositioning and mobilising.
Residential mental health and alcohol and other drug: Guidance
  • Service providers meet all needs, including needs for: 
    1. food and fluids
    2. hygiene 
    3. elimination 
    4. toilet
    5. repositioning and mobilising.
Public/private hospital: Guidance
  • Service providers meet all needs, including needs for: 
    1. food and fluids
    2. hygiene 
    3. elimination 
    4. toilet
    5. repositioning and mobilising.
Hospice: Guidance
  • Service providers meet all needs, including needs for: 
    1. food and fluids
    2. hygiene 
    3. elimination 
    4. toilet
    5. repositioning and mobilising.

Criterion 6.2.4

Aged care: Guidance
  • Service providers record any restraint resulting in mental, physical, or emotional harm to a person receiving care or support, or a person providing care or support as a moderate, major, or severe adverse event. 
  • Service providers recognise a post-traumatic stress response of a person who either receives or provides care or support.
  • The restraint register includes information on: 
    1. documentation of de-escalation techniques and health care and support worker interventions before the event
    2. alternative interventions used before the use of restraint
    3. the person being restrained
    4. restraint type (such as prone)
    5. duration of the restraint
    6. who approved the restraint
    7. health care and support workers who were involved and their level of training
    8. details of any resulting injury.
  • Physical restraint includes use of equipment such as rails.
  • A register does not replace the requirement to document the restraint event in records.
Residential disability: Guidance
  • Service providers record any restraint resulting in mental, physical, or emotional harm to a person receiving care or support, or a person providing care or support as a moderate, major, or severe adverse event. 
  • Service providers recognise a post-traumatic stress response of a person who either receives or provides care or support.
  • Service providers should record any personal restraint as a moderate, major, or severe adverse event. 
  • All personal plans include interests and preferred activities that prevent or alleviate boredom and foster the wellbeing of a person receiving services.
  • Service providers keep good documentation on triggers for a person as well as effective de-escalation strategies
  • Service providers should constantly update behaviour care or support plans and review them along with progress notes.
  • For guidance on adverse event reporting, see Health Quality & Safety Commission (2017) Severity Assessment Code (SAC) rating and triage tool for adverse event reporting (PDF, 86 KB).
  • The restraint register includes information on: 
    1. documentation of de-escalation techniques and health care and support worker interventions before the event
    2. alternative interventions used before the use of restraint
    3. the person being restrained
    4. restraint type (such as prone)
    5. duration of the restraint
    6. who approved the restraint
    7. health care and support workers who were involved and their level of training
    8. details of any resulting injury.
  • Physical restraint includes use of equipment such as rails.
  • A register does not replace the requirement to document the restraint event in records.
Residential mental health and alcohol and other drug: Guidance
  • Service providers record any restraint resulting in mental, physical, or emotional harm to a person receiving care or support, or a person providing care or support as a moderate, major, or severe adverse event. 
  • Service providers recognise a post-traumatic stress response of a person who either receives or provides care or support.
  • Service providers should record any personal restraint as a moderate, major, or severe adverse event. 
  • All personal plans include interests and preferred activities that prevent or alleviate boredom and foster the wellbeing of a person receiving services.
  • Service providers keep good documentation on triggers for a person as well as effective de-escalation strategies
  • Service providers should constantly update behaviour care or support plans and review them along with progress notes.
  • For guidance on adverse event reporting, see Health Quality & Safety Commission (2017) Severity Assessment Code (SAC) rating and triage tool for adverse event reporting (PDF, 86 KB).
  • The restraint register includes information on: 
    1. documentation of de-escalation techniques and health care and support worker interventions before the event
    2. alternative interventions used before the use of restraint
    3. the person being restrained
    4. restraint type (such as prone)
    5. duration of the restraint
    6. who approved the restraint
    7. health care and support workers who were involved and their level of training
    8. details of any resulting injury.
  • Physical restraint includes use of equipment such as rails.
  • A register does not replace the requirement to document the restraint event in records.
Public/private hospital: Guidance
  • Service providers record any restraint resulting in mental, physical, or emotional harm to a person receiving care or support, or a person providing care or support as a moderate, major, or severe adverse event. 
  • Service providers recognise a post-traumatic stress response of a person who either receives or provides care or support.
  • Service providers should record any personal restraint as a moderate, major, or severe adverse event. 
  • All personal plans include interests and preferred activities that prevent or alleviate boredom and foster the wellbeing of a person receiving services.
  • Service providers keep good documentation on triggers for a person as well as effective de-escalation strategies
  • Service providers should constantly update behaviour care or support plans and review them along with progress notes.
  • For guidance on adverse event reporting, see Health Quality & Safety Commission (2017) Severity Assessment Code (SAC) rating and triage tool for adverse event reporting (PDF, 86 KB).
  • The restraint register includes information on: 
    1. documentation of de-escalation techniques and health care and support worker interventions before the event
    2. alternative interventions used before the use of restraint
    3. the person being restrained
    4. restraint type (such as prone)
    5. duration of the restraint
    6. who approved the restraint
    7. health care and support workers who were involved and their level of training
    8. details of any resulting injury.
  • Physical restraint includes use of equipment such as rails.
  • A register does not replace the requirement to document the restraint event in records.
Hospice: Guidance
  • Service providers record any restraint resulting in mental, physical, or emotional harm to a person receiving care or support, or a person providing care or support as a moderate, major, or severe adverse event. 
  • Service providers recognise a post-traumatic stress response of a person who either receives or provides care or support.
  • Service providers should record any personal restraint as a moderate, major, or severe adverse event. 
  • All personal plans include interests and preferred activities that prevent or alleviate boredom and foster the wellbeing of a person receiving services.
  • Service providers keep good documentation on triggers for a person as well as effective de-escalation strategies
  • Service providers should constantly update behaviour care or support plans and review them along with progress notes.
  • For guidance on adverse event reporting, see Health Quality & Safety Commission (2017) Severity Assessment Code (SAC) rating and triage tool for adverse event reporting (PDF, 86 KB).
  • The restraint register includes information on: 
    1. documentation of de-escalation techniques and health care and support worker interventions before the event
    2. alternative interventions used before the use of restraint
    3. the person being restrained
    4. restraint type (such as prone)
    5. duration of the restraint
    6. who approved the restraint
    7. health care and support workers who were involved and their level of training
    8. details of any resulting injury.
  • Physical restraint includes use of equipment such as rails.
  • A register does not replace the requirement to document the restraint event in records.

Criterion 6.2.5

Aged care: Guidance
  • Service providers have implemented processes around emergency restraint. These should include a documented discussion with whānau or a person who holds an enduring power of attorney (if activated). A suggested framework for the debrief is to discuss:
    1. what caused the distress 
    2. the reason given for the restraint
    3. the way people felt before, during, and after the event
    4. giving whānau an active role in this process if they desire 
    5. what could be done differently
    6. suggestions or ideas to prevent restraint events in the future
    7. the role of whānau at the onset and evaluation of restraint. 
Residential disability: Guidance
  • Service providers have implemented processes around emergency restraint. These should include a documented discussion with whānau or a person who holds an enduring power of attorney (if activated). A suggested framework for the debrief is to discuss:
    1. what caused the distress 
    2. the reason given for the restraint
    3. the way people felt before, during, and after the event
    4. giving whānau an active role in this process if they desire 
    5. what could be done differently
    6. suggestions or ideas to prevent restraint events in the future
    7. the role of whānau at the onset and evaluation of restraint. 
Residential mental health and alcohol and other drug: Guidance
  • Service providers have implemented processes around emergency restraint. These should include a documented discussion with whānau or a person who holds an enduring power of attorney (if activated). A suggested framework for the debrief is to discuss:
    1. what caused the distress 
    2. the reason given for the restraint
    3. the way people felt before, during, and after the event
    4. giving whānau an active role in this process if they desire 
    5. what could be done differently
    6. suggestions or ideas to prevent restraint events in the future
    7. the role of whānau at the onset and evaluation of restraint. 
Public/private hospital: Guidance
  • Service providers have implemented processes around emergency restraint. These should include a documented discussion with whānau or a person who holds an enduring power of attorney (if activated). A suggested framework for the debrief is to discuss:
    1. what caused the distress 
    2. the reason given for the restraint
    3. the way people felt before, during, and after the event
    4. giving whānau an active role in this process if they desire 
    5. what could be done differently
    6. suggestions or ideas to prevent restraint events in the future
    7. the role of whānau at the onset and evaluation of restraint. 
Hospice: Guidance
  • Service providers have implemented processes around emergency restraint. These should include a documented discussion with whānau or a person who holds an enduring power of attorney (if activated). A suggested framework for the debrief is to discuss:
    1. what caused the distress 
    2. the reason given for the restraint
    3. the way people felt before, during, and after the event
    4. giving whānau an active role in this process if they desire 
    5. what could be done differently
    6. suggestions or ideas to prevent restraint events in the future
    7. the role of whānau at the onset and evaluation of restraint. 

Criterion 6.2.6

Guidance has not been developed for this criterion.

Criterion 6.2.7

Aged care: Guidance
  • Service providers have an implemented process to monitor restraint that relates to identified risks.
Residential disability: Guidance
  • Service providers consider the impact of restraint on other people receiving services. For example, at times people are refused access to an outdoor space because others in the home are in secure care. This form of restraint – where a person is restricted from certain areas because another flatmate cannot access them – should never occur.
Residential mental health and alcohol and other drug: Guidance
  • Service providers inform whānau of any restraint event and include them in the evaluation of a restraint.
Public/private hospital: Guidance
  • Service providers have an implemented process to monitor restraint that relates to identified risks.
  • Service providers inform whānau of any restraint event and include them in the evaluation of a restraint.

Criterion 6.2.8

Residential disability: Guidance
  • Service providers involve health care and support workers in follow-up actions.
  • The debrief supports the wellbeing of health care and support workers, maximises learning from the evaluation of the restraint incident, and reflects the perspectives of the person receiving services, their whānau, and Māori and other cultural worldviews. 
Residential mental health and alcohol and other drug: Guidance
  • Service providers involve health care and support workers in follow-up actions.
  • The debrief supports the wellbeing of health care and support workers, maximises learning from the evaluation of the restraint incident, and reflects the perspectives of the person receiving services, their whānau, and Māori and other cultural worldviews. 
Public/private hospital: Guidance
  • Service providers involve health care and support workers in follow-up actions.
  • The debrief supports the wellbeing of health care and support workers, maximises learning from the evaluation of the restraint incident, and reflects the perspectives of the person receiving services, their whānau, and Māori and other cultural worldviews. 
Hospice: Guidance
  • Service providers involve health care and support workers in follow-up actions.
  • The debrief supports the wellbeing of health care and support workers, maximises learning from the evaluation of the restraint incident, and reflects the perspectives of the person receiving services, their whānau, and Māori and other cultural worldviews. 

Section 6.3: Quality review of restraint

Criterion 6.3.1

Aged care: Guidance
  • Service providers include the use of restraint in their annual internal audit programme. This may include a review of restraint use, restraint incidents, and education needs. The outcome of internal audit goes through to the restraint committee or quality meeting.
Residential disability: Guidance
  • Service providers include the use of restraint in their annual internal audit programme. This may include a review of restraint use, restraint incidents, and education needs. The outcome of internal audit goes through to the restraint committee or quality meeting.
Residential mental health and alcohol and other drug: Guidance
  • Service providers include the use of restraint in their annual internal audit programme. This may include a review of restraint use, restraint incidents, and education needs. The outcome of internal audit goes through to the restraint committee or quality meeting.
Public/private hospital: Guidance
  • Service providers include the use of restraint in their annual internal audit programme. This may include a review of restraint use, restraint incidents, and education needs. The outcome of internal audit goes through to the restraint committee or quality meeting.
Hospice: Guidance
  • Service providers include the use of restraint in their annual internal audit programme. This may include a review of restraint use, restraint incidents, and education needs. The outcome of internal audit goes through to the restraint committee or quality meeting.

Section 6.4: Seclusion

Public/private hospital: Guidance

Criterion 6.4.1

  • Service providers only use seclusion as a last resort and when there is an assessed imminent risk to the safety of the person and all others involved.

Criterion 6.4.2

  • Data includes:
    1. rationale and clinical review
    2. number of people secluded
    3. number of seclusion events
    4. demographics
    5. duration of seclusion events in hours
    6. any personal restraints taken in order to achieve the seclusion
    7. any specific issues related to each seclusion event.

Criterion 6.4.3

  • If service providers use seclusion, they must always explain the event to the person receiving services and their whānau in a culturally appropriate way and check with them that they understand what is happening to them and the length of time they will be secluded.

Criterion 6.4.4

  • Service providers whakapaepae (pay attention to) the environment to avoid seclusion by making available a space of nohopuku (silence, quiet, and inactivity).

Criterion 6.4.5

  • Service providers acknowledge and observe cultural practices; for example, they:
    1. do not allow food to be eaten on a bed
    2. make available kaumātua or health care and support workers who the person receiving services can identify with to support the person.

Criterion 6.4.6

Guidance has not been developed for this criterion.

Criterion 6.4.7

Guidance has not been developed for this criterion.

Criterion 6.4.8

Guidance has not been developed for this criterion.

Criterion 6.4.9

Part 5: Infection prevention and antimicrobial stewardship Up to First page

Page last updated: 28 February 2023

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