1. Guidelines for Record Keeping
It is a legal requirement for all staff to report any incident in which their safety is compromised.
(RIDDOR)
Where the agency policy makes it clear that staff are expected to report violent incidents, staff could be held to account by courts and tribunals for any breach and they could find compensation or insurance claims may be affected.
PAMOVA Cymru (GS) Ltd

2. Guidelines for Record Keeping Cont...
The content and style should be………
Factual, consistent and accurate.
Written as soon as possible after an incident.
Written clearly in terms that staff and clients understand.
Written not to include abbreviations, jargon, meaning phrases irrelevant speculation or subjective statements.
PAMOVA Cymru (GS) Ltd

3. If an agency seeks support of a health and safety approach to handling violence involving the use of disengaging and immobilising techniques, then every part of the jigsaw must be present and in it’s proper place.
In the event of something going wrong, of a compensation claim being made against agency and / or staff, or of a criminal investigation of possible assault, both the agency and the member of staff would be required to demonstrate that agency policy, including proper reporting and recording, has been followed from A to Z.
PAMOVA Cymru (GS) Ltd

4. National Minimum Standards State
Made within 24 hours
Include the name of the child
The date and time
The location of the intervention
The lead up and behaviour requiring the use of restraint
The technique used
The duration of restraint
Name of staff members involved
PAMOVA Cymru (GS) Ltd

5. National Minimum Standards State
Name of staff members involved
Names of any persons witnessing the intervention/restraint
The effectiveness of the restraint
Any injuries to child or staff/others
The signature of staff member recording the incident
If injuries are sustained these should be recorded in the accident book
PAMOVA Cymru (GS) Ltd

6. National Minimum Standards State
Witness Statements’ should be recorded and submitted along with the ‘Incident Report’ by all staff involved and/or present during the incident
The child/children involved in the incident should be given the opportunity to discuss the incident and express their views/feelings
PAMOVA Cymru (GS) Ltd

7. Childs File
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;
PAMOVA Cymru (GS) Ltd

8. To Summarise
Record keeping is a vital part of your work and the mark of a skilled professional.
Assume that any documented work can or will be scrutinised by professionals at some point.
Be factual, concise and accurate.
Relay the incident so clients/patients and like minded professionals can understand.
Or 12 randomly selected individuals from your community to understand !
PAMOVA Cymru (GS) Ltd

9. The Witness Statement Introduce yourself and where you work.
State the day / date and hours of work you were working and what staff were on shift with you.
State the time (approximately) your attention was brought to the incident and where you were situated.
PAMOVA Cymru (GS) Ltd

10. The Witness Statement
State where the subject was located and what he/ she /they were doing e.g. note down their behaviour (body language/actions);
Quote the subject directly, if possible.
State what action from the subject prompted you to intervene.
State what action you employed and state which staff were assisting you;
State what time (approximately) your intervention had come to an end.
PAMOVA Cymru (GS) Ltd

11. The Witness Statement
Note down any injuries sustained by yourself/staff/subject. (Note down if there were no injuries sustained to either parties involved);
State the after-care rendered to yourself/ staff/subject, e.g, first-aid, de-briefing;
Sign at the bottom of the witness statement together with your job title and date.
PAMOVA Cymru (GS) Ltd

12. The Witness Statement
If the witness statement is not completed on the same day as the incident, state as to why !
PAMOVA Cymru (GS) Ltd

13. Client/Patient Notes
Follow the same format as the ‘Witness Statement’. However, disregard the advice on: where you work; where you are based and your hours of work;
PAMOVA Cymru (GS) Ltd

14. To Summarise
Record keeping is a vital part of your work and the mark of a skilled professional.
Assume that any documented work can or will be scrutinised by professionals at some point.
Be factual, concise and accurate.
Relay the incident so clients/patients and like minded professionals can understand.
Or 12 randomly selected individuals from your community to understand !
PAMOVA Cymru (GS) Ltd

15. Any Questions?
PAMOVA Cymru (GS) Ltd

16. Associated Risks Within Restraint
Blood Born Infections
Substance Misuse Associated Behaviours
Excited Delirium
Positional Asphyxia
PAMOVA Cymru (GS) Ltd

17. Associated Risks Within Restraint
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.
PAMOVA Cymru (GS) Ltd

18. Associated Risks Within Restraint
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.
PAMOVA Cymru (GS) Ltd

19. Associated Risks Within Restraint
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.
PAMOVA Cymru (GS) Ltd

20. EXCITED DELIRIUM
PAMOVA Cymru (GS) Ltd

21. Definition
Excited delirium is a rare form of SEVERE MANIA sometimes part of the spectrum of manic-depressive psychosis and chronic schizophrenia
PAMOVA Cymru (GS) Ltd

22. Excited Delirium Cocaine induced psychosis Acute exhaustive mania
Also known as:
Agitated delirium
Cocaine induced psychosis
Acute exhaustive mania
PAMOVA Cymru (GS) Ltd

23. It is characterised by purposeless, often violent activity coupled with incoherent or often meaningless speech and hallucinations with paranoid delusions
PAMOVA Cymru (GS) Ltd

24. Excited Delirium can be caused by
Psychiatric illness (combined with Drink and or Drugs)
Drug intoxication (Cocaine is the best known cause of excited Delirium)
Alcohol
PAMOVA Cymru (GS) Ltd

25. Effects of Excited Delirium
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
PAMOVA Cymru (GS) Ltd

26. Symptons of Excited Delirium
Violence towards others
Unexpected physical strength
A diminished sense of pain
Sweating, fever, heat intolerance
Sudden tranquillity after frenzied activity
PAMOVA Cymru (GS) Ltd

27. Death can occur Before a struggle During a struggle During restraint
After restraint
PAMOVA Cymru (GS) Ltd

28. Identifying Excited Delirium
Bizarre and or aggressive behaviour
Impaired thinking
Disorientation
Hallucinations
Acute onset of paranoia
Shouting
Strange behaviour such as smashing windows stripping down to the waist
tolerance to incapacitant sprays should the police be called to the scene
PAMOVA Cymru (GS) Ltd

29. BE AWARE OF Sudden Passivity Pulse rate Breathing Temperature
PAMOVA Cymru (GS) Ltd

30. POSITIONAL ASPHYXIA
PAMOVA Cymru (GS) Ltd

31. POSITIONAL ASPHYXIA 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).
PAMOVA Cymru (GS) Ltd

32. What are the risk factors
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
PAMOVA Cymru (GS) Ltd

33. Cause of death / or serious injury
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.
PAMOVA Cymru (GS) Ltd

34. WHAT YOU SHOULD NOT DO 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.
PAMOVA Cymru (GS) Ltd

35. WHAT YOU SHOULD NOT DO 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.
PAMOVA Cymru (GS) Ltd

36. WHAT YOU SHOULD NOT DO
State the Dangers
PAMOVA Cymru (GS) Ltd

37. WHAT YOU SHOULD DO Chair restraint:
Using an appropriate fore arm hold (finger & thumb) patient is securely held without any immediate risks to staff or the clients safety.
PAMOVA Cymru (GS) Ltd

38. WHAT YOU SHOULD DO 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.
PAMOVA Cymru (GS) Ltd

39. After
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.
where has been prolonged struggle, potential exacerbated by a hot environment or heavy clothing need to be aware of the risk of overheating/dehydration. Loosen/remove clothing, enable the individual to drink where possible ( not too hot or cold, sitting position) stopping and resting.
Need to know as much as possible about the history of the individual. ?pre-existing cardiovascular/respiratory problems, have they just eaten/drank,medication pre/during/post
If the individual is sleeping, the recovery position should be effected.
PAMOVA Cymru (GS) Ltd

40. Summary
Be aware:
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
after restraint vital signs must be observed if there is any indication of risk
Pre during and post incident awareness of medication
caution must be observed in administering medication
PAMOVA Cymru (GS) Ltd

41. Any Questions?
PAMOVA Cymru (GS) Ltd