Recent findings of absent or improper monitoring in the use of restraints at the Lacombe Hospital and Care Centre have prompted calls for greater oversight into how and why restraints are used in seniors facilities across Alberta.
A review of the Lacombe Hospital and Care Centre found that “multiple clients” were being physically restrained with no indication the practice had been ordered by a physician.
The review was conducted only after nursing students from Red Deer College raised concerns in March during a practicum at the facility.
Leaked documents with details of the review were made public by the opposition last week, when Wildrose Leader Brian Jean told the legislature conditions in the facility were “appalling.”
Sandra Azocar, executive director of Friends of Medicare, says the government needs to tighten up its oversight of how restraints are used in seniors-care facilities. (Linked-In)
According to the documents, some clients “had seatbelts without physicians’ orders in place, monitoring, review or documentation in the care plan.”
Similar problems were also found with the use of “pharmacological restraints,” which are prescribed medications that Friends of Medicare health advocate Sandra Azocar said are another way to describe “sedation, anti-depressants, and anti-anxiety medication.”
Under AHS procedures noted in the review, a physician or care team is required to monitor a patient restraint prescription each month.
But that wasn’t always the case at the Lacombe facility, where “medication reviews by the physician did not always occur at a minimum of once a month,” according to findings of the review.
Concerns raised by seniors and families
Azocar said the use of restraints and medications has frequently been raised as an area of concern in meetings across Alberta with seniors and their families.
“There’s quite a bit of a theme happening across the province in seniors care, when it comes to the use of these (restraints),” said Azocar.
Family members are often worried “there’s a bit of an overuse,” she said.
Friends of Medicare thinks there should be greater oversight of restraint usage in all facilities.
“It’s definitely an area where the province needs to put a little bit more oversight and certainly focus on, in terms of how do we make somebody’s life a little more bearable when they’re in a facility,” said Azocar.
Lori Sparrow, senior health executive for AHS central zone, wouldn’t comment on the Lacombe findings, because of an ongoing investigation into the problems discovered there.
But Sparrow said every facility is expected to follow a “restraint procedure.”
“If it’s found that restraint-as-a-last-resort procedure is not being followed,” said Sparrow, “then we’ll go in and investigate and provide additional education and training for all those who are involved.”
Restraints should be ‘a last resort’
Sparrow said patients who are restrained are required to be monitored and reassessed every three months, or more often if necessary.
“We have a least-restraint policy,” said Sparrow. “We want to ensure we’re using restraining as a last resort.”
Restraint should only be used when a patient poses a danger to themselves or others, she said.
Sparrow said facility audits are performed every two years to ensure standards are being followed.
Despite concerns expressed to Friends of Medicare about restraints, performance measures tracked by the Canadian Institute of Health Research show the rate of usage of chemical and physical restraints in Alberta is below the national average, and declining.
As of November 2016, the CIHI data shows 6.9 per cent of residents in Alberta long-term care facilities were restrained, compared to the national average of 7.4 per cent. The Alberta percentage compared to 8.6 per cent the previous year.
A review of operations at the Lacombe Hospital and Care Centre uncovered problems with the use of mechanical and pharmacological restraints. (Google)
There has also been a steady drop in the use of anti-psychotic drugs in Alberta as a restraining measure in seniors care, according to the CIHI report.
What CIHI calls “potentially inappropriate” use of anti-psychotic drugs in Alberta long-term care facilities has dropped in recent years, from a peak of 36 per cent in north zone facilities in 2012-2013 to 24.8 per cent in 2015-2016. CIHI said the measure tracks “the percentage of residents who receive an anti-psychotic medication without a diagnosis of psychosis.”
CIHI said the overall number for Alberta is now at 18.1 per cent, compared to 26.5 per cent in 2012-2013.
Anti-psychotic drugs, according to CIHI, are “a class of medication used for the treatment of acute and chronic psychosis” that could have adverse effects, especially on seniors. They are deemed appropriate, however, “when used in the treatment of chronic mental health conditions, such as schizophrenia and to manage psychosis,” such as hallucinations.
As a result of the findings of the Lacombe hospital review, AHS placed three staff members on administrative leave, ordered more staff training, and launched investigations.
One investigation is being conducted under the the Protection for Persons in Care unit of Alberta Health.
The group responds to reports of potential abuse of patients in hospitals or nursing homes, in addition to examining accommodation standards.