State seeks to amend law on restraining dangerous hospital patients
A Tallinn hospital has welcomed a law change which would allow dangerous patients in healthcare institutions to be restrained where necessary, but adds greater resources are needed in allowing caregivers to be involved in the process, alongside nurses and doctors.
Up to now, a patient can only legally be restrained if they are housed within a hospital's psychiatric ward.
The Ministry of Social Affairs, which has sent the bill for its coordination rounds, gives an example situation, in the bill's explanatory memorandum, where a patient suffering from dementia gets aggressive, or even attacks staff or other patients in the hospital, or behaves in another way that is dangerous to both themselves and those around them.
It had been legally unclear whether restraint measures could be used in these cases.
Made Bambus, adviser at the ministry's health services department, said that the aim is to regulate this gray area.
"For example, in the emergency room, these situations can occur quite frequently, where it is simply not possible to help a person without restraining them, yet the current legal framework does not allow for this at all. It gets done because people are forced into such situations, which may be the reason why they don't really want to document it," Bambus said.
Bambus stressed the main principle being that restraint must always be a last resort.
The legislative amendment, if it passes, would allow legal intervention and preserve the safety of the patient and those around them.
Of the actual mechanics of restraint, Bambus listed three, plus one which is now excluded in the draft bill.
These are: "Physical restraint, mechanical fixation such as restraint straps — that is the immobilization of limbs; chemical restraint, meaning the injection of sedatives, while the fourth measure is placement in an isolation room, but with this legislative amendment, we have now completely excluded that fourth measure," Bambus said.
Kerstin Hindrimäe, head of patient safety and development at Tallinn's North Estonia Medical Center (PERH), said that while restraint is not a day-to-day practice, dangerous patients are also encountered outside the field of psychiatry.
"The occurrence of delirium can happen after surgery or due to chronic illness. Naturally, we have also received patients who are under the influence of alcohol or narcotics, and in those situations, they may pull out vital cannulas, drains, or catheters. They may get out of bed, even though their health condition does not allow for that. Plus, unfortunately, some patients can also be aggressive," Hindrimäe said.
After restraining an individual, that individual must be placed under constant supervision by a healthcare worker. Hindrimäe said this supervision could also be carried out by trained caregivers, as current resources do not allow for it.
"Under current conditions, where we already have a limited number of healthcare workers in Estonia, fulfilling this requirement is practically impossible. Involving trained caregivers for supervision is important to free up the limited resources of healthcare workers and allow them to continue treating other patients," Hindrimäe went on.
The Ministry of Social Affairs said it was open to considering this proposal.
The legislative amendment does not, however, extend to the fields of social care and education, even as, as Bambus acknowledged, similar issues can also arise in care homes, if not as much.
"We started with healthcare services now as this is the most acute area, here we have the most experience, and from this experience, we can move on to social services," Bambus added.
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Editor: Andrew Whyte, Aleksander Krjukov
