An Act to amend the
Public Hospitals Act
to regulate the use of
restraints that are not
part of medical treatment
Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:
1. The Public Hospitals Act is amended by adding the following section:
34.1 (1) A hospital may use a restraint for a patient only in accordance with this section.
(2) In this section, "
restraint" means a physical restraint in the form of a device, apparatus or barrier used to restrict a patient's freedom of movement for purposes other than medical treatment of the patient; ("mesure de contention") "
substitute decision-maker" means a patient's substitute decision-maker under Part II of the Health Care Consent Act, 1996. ("mandataire spcial")
(3) A hospital may use a restraint only if all of the following conditions are satisfied:
1.The use of the restraint is necessary to protect the patient or others from serious bodily injury.
2.Consent to the use of the restraint is given by the patient or by the patient's substitute decision-maker, if the patient is incapable of giving consent.
3.The use of the restraint is ordered in writing by a physician.
(4) Despite paragraph 2 of subsection (3), a restraint may be used without the consent of the patient or the patient's substitute decision-maker if immediate action is necessary to prevent serious bodily injury to the patient or to others.
(5) In making an order for the use or continued use of a restraint, a physician shall determine the type of restraint that will provide the necessary protection with the least restriction on the patient and shall specify the use of that type of restraint in the order.
No physical injury
(6) A restraint must be designed not to cause physical injury to the patient and must be designed to cause the least amount of discomfort to the patient.
(7) A restraint may be applied only by a person who has received appropriate training on the proper use of the restraint, on alternate types of restraints and on other methods to identify and resolve situations that may otherwise require the use of a restraint.
Duration of use
(8) A restraint must not be used for a period longer than necessary and, in no case, for a period exceeding two hours unless a physician reassesses the need for the restraint and gives a new written order under this section.
(9) Hospital staff shall examine a patient at least every 15 minutes while the patient's freedom of movement is restricted by a restraint and shall change the patient's position every hour.
(10) Every use of a restraint must be noted on the patient's chart with the following information:
1.The type of restraint used.
2.The date, the time and the length of time the restraint is used.
3.The types of less restrictive restraints considered by the physician and the reasons they were not specified in the order.
4.If appropriate for the patient, information on treatment planning designed to reduce the need to use a restraint.
Disclosure of information
(11) If a restraint is used without the consent of the patient or the patient's substitute decision-maker in circumstances described in subsection (4), the hospital shall disclose the information described in subsection (10) concerning the use of the restraint to the patient or the substitute decision-maker within a reasonable time after the use of the restraint.
(12) A restraint must not be used for any of the following purposes:
1.Replacement of personal attention to the patient or to reduce the need for staff supervision or medical treatment of the patient.
2.Punishment of the patient.
3.Convenience of the hospital staff.
Policies and procedures
(13) Every hospital shall establish written policies and procedures governing the use of restraints that comply with the requirements listed in subsections (3) to (12).
Available to patients
(14) Every hospital shall provide a copy of its policies and procedures governing the use of restraints to patients on admission to the hospital and shall post the policies and procedures in patient rooms.
2. This Act comes into force on the day it receives Royal Assent.
3. The short title of this Act is the Public Hospitals Amendment Act (Patient Restraints), 2000.
The Bill amends the Public Hospitals Act to enact new section 34.1 to regulate the use of restraints that are not part of a patient's medical treatment. A restraint may be used only on the written order of a physician to protect the patient or others from serious bodily injury. The least restrictive restraint that will provide the necessary protection must be used. The use of a restraint in excess of two hours requires reassessment and a new order by a physician. Policies and procedures governing the use of restraints must be established by hospitals, consistent with the rules set out in the section. The policies and procedures must be provided to patients on admission and posted in patient rooms.