Wheelchair brakes a restraint in LTC?

[PoultryGirl17, BSN]

I'm looking for Canadian (esp Ontario) guidelines and standards, but actual professional practices and related experiences are welcome.

I'm a first year, mature BScN student in LTC placement, and I understand that the theory we learn in class doesn't always translate completely to actual practice, but this one is piquing my curiosity and challenging my thinking skills.

After feeding a non-ambulatory, aphasic resident, I returned her to her room in her wheelchair, but had to wait for staff to complete her transfer (ceiling lift) to her bed. I stepped out in the hall to greet the PSWs and as I reoriented the resident's wheelchair for the transfer, I unlocked the brakes I had applied and said how in class and lab it had been drilled in that we always have to make sure that safety precaution is taken. The PSW then explained to me that applying the brakes like that (and leaving the resident, even momentarily) would actually be considered a restraint and a fine could result if the Ministry should happen to witness it during an inspection.

I gently probed the logic (isn't it a safety issue so the resident doesn't inadvertently roll?), but didn't want the PSWs to feel defensive--after all, I'm just a newbie student and they have years of experience. I did bring it up with my clinical instructor after the occurrence, and she too was very surprised and was going to get more information.

I'm sure it would not be considered a restraint if the patient was able to unlock and propel the chair themselves, but it isn't so clear when the patient is dependent, so I understand it may very well be possible.

Can anyone direct me to actual documentation that would address this?

Thank you!

[wanderlustnurse88, RN]

I've never heard of this but at my work, tilting someone back in a wheelchair is considered a PASD which is a personal assistive safety device. Bed rails, even if they are partial or are only there for mobility aids are considered a PASD. I'm wondering if brakes would be under the same category. Our seat belt restraints are only considered restraints if the resident cannot do/undo independently. Perhaps same idea as the brakes. If they cannot undo the brakes, it would be considered a restraint.

[joanna73, BSN, RN]

I've never heard this either and I am familiar with restraint policies. A wheel chair seat belt or lap tray is considered a restraint, not applying brakes.

Similarly, documentation needs to follow restraints. I would be interested to know how frequently their documentation is happening if brakes are considered a restraint.

You should research the facility policy on restraints because it can vary.

[mindofmidwifery, ADN]

I'm not from Canada but the LTC facility I worked at in the US told me not to lock wheelchair brakes because that's considered a restraint. Not sure how true this is...

[joanna73, BSN, RN]

In order to clarify your question and find the rationale, you need to locate the facility policy. The policy will outline what they consider to be a restraint.

It doesn't matter what we say, OP because each facility will decide and their policy will guide your actions.

[joanna73, BSN, RN]

In order to clarify your question and find the rationale, you need to locate the facility policy. The policy will outline what they consider to be a restraint.

It doesn't matter what we say, OP because each facility will decide and their policy will guide your actions.

[emmy27]

I am American, but the rationale we were taught is that anything that limits a patient's actual abilities and can't be voluntarily undone by them is a restraint and needs to be documented as such.

So for a patient who is capable of moving their own wheelchair but not able to undo the brakes themselves, brakes would be a restraint. For a patient who is not capable of moving their own wheelchair, they would not be a restraint (they are not restraining the patient from doing anything). For a patient who is capable of removing the brakes themselves, also not a restraint (patient is not restrained by them).

This may not be the policy where you are, but it's something that has stuck in my head as a way to ethically consider unusual scenarios that are potentially restraints. Of course familiarize yourself with each institution's individual policies, as they may be more conservative.

[PoultryGirl17, BSN]

Yes, Joanna73, the clinical instructor was going to get details about the facility's policy, but wouldn't the MOHLTC ultimately set out acceptable practices?

[PoultryGirl17, BSN]

Emmy27, yes, I believe this may be the rationale behind it, which would be logical; but I wonder about the situation of this particular resident and many like her, anywhere she is she is unable to move independently. She wasn't my assigned patient and I don't know what her diagnosis is, but the only voluntary movement I witnessed was unilateral, forearm and hand. Full bed rails (restraints) were also part of regular care. Do you get what I mean? Just sitting in the wheelchair, brakes or not, would be a restraint for her because she cannot get out of it no matter what. Maybe I'm splitting hairs and need to focus on the big picture.

[PoultryGirl17, BSN]

Thanks for all the different points of view, I appreciate it. I do hope the clinical instructor will be able to clarify for me next week.

[joanna73, BSN, RN]

Yes that's true and the facility should be following their guidelines. However, since there are always variations, you should always be aware of your facility policy because they will dictate how the work is performed.