PAMOVA Cymru (GS) Ltd It is a legal requirement for all staff to report any incident in which their...

PAMOVA Cymru (GS) LtdPAMOVA Cymru (GS) Ltd

Made within 24 hoursMade within 24 hours Include the name of the childInclude the name of the child The date and timeThe date and time The location of the interventionThe location of the intervention The lead up and behaviour requiring the use of The lead up and behaviour requiring the use of

restraintrestraint The technique usedThe technique used The duration of restraintThe duration of restraint Name of staff members involvedName of staff members involved

Name of staff members involvedName of staff members involved Names of any persons witnessing the Names of any persons witnessing the

intervention/restraintintervention/restraint The effectiveness of the restraintThe effectiveness of the restraint Any injuries to child or staff/othersAny injuries to child or staff/others The signature of staff member recording the The signature of staff member recording the

incidentincident If injuries are sustained these should be recorded If injuries are sustained these should be recorded

in the accident bookin the accident book

Witness Statements’ should be recorded and Witness Statements’ should be recorded and submitted along with the ‘Incident Report’ by all submitted along with the ‘Incident Report’ by all staff involved and/or present during the incidentstaff involved and/or present during the incident

The child/children involved in the incident should The child/children involved in the incident should be given the opportunity to discuss the incident be given the opportunity to discuss the incident and express their views/feelingsand express their views/feelings

• Follow the same format as the ‘Witness / Incident form’. However, disregard the advice on: where you work; where you are based and your hours of work;

Record keeping is a vital Record keeping is a vital part of your work and the part of your work and the mark of a skilled mark of a skilled professional.professional.

Assume that any Assume that any documented work can or documented work can or will be scrutinised by will be scrutinised by professionals at some professionals at some point.point.

Be factual, concise and Be factual, concise and accurate.accurate.

Relay the incident so Relay the incident so clients/patients and like clients/patients and like minded professionals can minded professionals can understand.understand.

Or 12 randomly selected individuals from your community to understand !

PAMOVA Cymru (GS) Ltd

Blood Born Infections Substance Misuse Associated Behaviours Excited Delirium Positional Asphyxia

HIV rates amongst injecting drug users are low 1 – 2% needle stick injuries.

Be aware of unsheathed needles about the person that can pass on HIV and hepatitis.

Hepatitis rates are high up to 50% of drug users.

If you come into contact with any fluids from service users you should be vaccinated against the risks, and cover any open wounds you may have as a matter of course.

Some substances of misuse can induce paranoia stimulants such as amphetamine, cocaine, crack cocaine and cannabis can induce paranoia.

Anabolic steroids to can cause paranoia and irritability and unfortunately lots of muscles too.

Definition

Excited delirium is a rare form of SEVERE MANIA

sometimes part of the spectrum of manic-

depressive psychosis and chronic schizophrenia

Also known as:

• Agitated delirium

• Cocaine induced psychosis

•Acute exhaustive mania

It is characterised by purposeless, often violent

activity coupled with incoherent or often meaningless speech and

hallucinations with paranoid delusions

•Psychiatric illness (combined with Drink and or Drugs)

•Drug intoxication (Cocaine is the best known cause of excited Delirium)

•Alcohol

• Abnormal Strength

• High tolerance to pain

• Skin may be hot to touch

• Quick to fatigue - especially after a violent struggle

• Hypothermia is often associated with this syndrome

• Violence towards others

• Unexpected physical strength

• A diminished sense of pain

• Sweating, fever, heat intolerance

• Sudden tranquillity after frenzied activity

•Before a struggle

•During a struggle

•During restraint

•After restraint

• Bizarre and or aggressive behaviour

•Impaired thinking

•Disorientation

•Hallucinations

•Acute onset of paranoia

•Shouting

What is ‘Positional Asphyxia’

Positional asphyxia is a syndrome, which may be the sole or contributory factor in death, which may occur as a result of restraint being used

Breathing is a mechanical process involving the chest wall, rib cage, diaphragm and abdominal muscles, and if the movement of all, or any of these are significantly impaired for any length of time, then death may occur (as a consequence of hypoxia which may disturb the heart rhythm).

Positional asphyxia has been associated with a number of deaths during physical restraint, more usually during mechanical restraint but also during ‘hands on’ techniques, which physically restrict the person’s freedom of movement .

The available evidence suggests that a combination of factors may place individuals at risk of positional asphyxia:-

• Respiratory disorders

•Cardiovascular disorders

•Prescribed drugs

•Obesity

•Position during restraint

• Prolonged struggle

•Drug & Alcohol intoxication

•When we are presented with a threat to the neck , the sympathetic nervous system is activated -basic survival mechanism/personal defence.

•Sudden increase in blood pressure or pressure on the neck causes artificial stimulation of the nervous system, slowing down the heart rate.

•Reduction in blood pressure could cause fainting/blackouts and in the worst case scenario cardiac arrest leading to death.

Bed Restraint:

During restraint within a bedroom staff may be tempted to use the bed as a more comfortable option for restraint. This may however exacerbate the potential for positional asphyxia as staff may be more prone to adding extra pressure onto the upper torso without realising.

Floor restraint (hog tying)

The individual is being restrained in the prone position restraint hold, with hands on the upper back and also feet held in a figure four leg lock.

State the Dangers

Chair restraint:

Using an appropriate fore arm hold (finger & thumb) patient is securely held without any immediate risks to staff or the clients safety.

Rest position:

Arms are held in the rest position (triangular fix) by the side of individuals body. Legs are kept straight out and wrapped around the ankles.

NO PRESSURE MUST BE PUT ON THE TORSO EVEN IF THE INDIVIDUAL CONTINUES TO STRUGGLE.

•Individual needs to be observed, watching vital signs, for overheating and/or dehydration.

• Care and attention is vital, especially where the patient is secluded or left resting in bed.

• If the individual is sleeping, the recovery position should be effected.

•that no pressure is to be put onto the individual’s torso during any restraint

• that heart rate, respiration and body temperature can be affected during restraint

Be aware:

• after restraint vital signs must be observed if there is any indication of risk

• caution must be observed in administering medication

PAMOVA Cymru (GS) Ltd It is a legal requirement for all staff to report any incident in which their...

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