Restraint Training: Managing Distress and using force to clean a resident

The physical handling of any load or person is regulated under the Manual Handling Regulations 1992. The Regulations are made under the Health and Safety at Work etc Act 1974. They implement European Directive 90/269/EEC on the manual handling of all loads [including human patients- see Regulation 2(1)] supplement the general duties placed on employers and others by the Health and Safety at Work etc Act 1974 and the broad requirements of the Management of Health and Safety at Work Regulations 1999. Physical restraint of an uncooperative, aggressive and / or violent subject heightens the risk of injuries being caused due to the volatile nature and reason for the intervention. The injured person does not always make a full recovery; the result of which can be physical impairment or even permanent disability. The Regulations and Associated Guidance paragraphs establish a clear hierarchy of measures:

1: Avoid hazardous manual handling operations so far as is reasonably practicable. This may be done by redesigning the task to avoid moving the load or by automating or mechanising the process. 2: Make a suitable and sufficient assessment of any hazardous manual handling operations that cannot be avoided. 3: Reduce the risk of injury from those operations so far as is reasonably practicable. Particular consideration should be given to the provision of mechanical assistance. Where this is not reasonably practicable then other improvements to the task, the load and the working environment should be explored.

For this reason, any staff member who is tasked with, for example, cleaning a resident who is resisting efforts at personal care, is engaged in a manual handling activity. It can further be argued that at some point that task becomes one which can not be avoided. The Manual Handling Regulations require that the procedure they are using to carry out that task should be assessed in such a way as to reduce the risk.