Review of the Medical Theories and Research Relating to Restraint Related Deaths




НазваниеReview of the Medical Theories and Research Relating to Restraint Related Deaths
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Дата конвертации14.05.2013
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Review of the Medical Theories and Research Relating to Restraint Related Deaths


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2011

Caring Solutions (UK)

University of Central Lancashire


Contents


Acknowledgements 4

Authors 4

ForewordExecutive Summary 5

1.Introduction 7

2.Background to the Review 8

3.Aims and objectives 9

4Methodology 11

14.1 Establishing baseline dataset from the literature review 11

24.2 Gap analysis/expert review 11

34.3 Expert seminars 12

5Results of literature search 13

6Rationales for restraint 16

7De-escalation 17

8Physical restraint training and techniques 19

9Reporting mechanisms on restraint 20

10Incidents of restraint 21

11Sequalae of restraint incidents 23

12National and international variations 24

13Stakeholders’ perspectives 25

413.2 Learning disabilities 25

513.3 Healthcare settings 25

613.4 Custodial settings 27

14Incidents of restraint-related deaths 28

15.Vulnerable populations 30

715.3 Black and Minority Ethnic groups 33

815.4 Individuals with high body mass index 35

16.Medical theories and concepts 37

916.1 Positional asphyxia 41

1016.2 Excited delirium and acute behavioural disturbance 45

1116.3 Pre-existing conditions 48

1216.4 Stress-related cardiomyopathy 51

1316.5 Thromboembolic disease 51

1416.6 Catecholamine hyperstimulation 52

1516.7 Acidosis 52

1616.8 Alcohol abuse 53

1716.9 Neuroleptic medication 55

1816.10 Neuroleptic malignant syndrome 56

2.Current UK research projects 57

3.Characteristics of individuals in UK restraint-related deaths 1999-2010 57

4.Expert opinion 60

5.Gap Analysis 66

6.Implications for practice 68

2021.2 Reporting 69

2121.3 Training 70

2221.4 Risk assessment and management 71

2321.5 Management of acute behavioural disturbance and excited delirium 72

2421.6 Polypharmacy 73

2521.7 Pre-existing conditions 73

7.Conclusions 74

Glossary 76

Appendix 1 Relevant studies 79

Appendix 2 Hierarchy of evidence 88

Appendix 3 Restraint-related deaths 1st Jan 1999- 1st Jan 2010 89

Appendix 4 Expert opinion 96

Appendix 5 Signs and symptoms of medical conditions 97

Appendix 6 Useful links 98

References 99



Figure 1 Multifactorial causes of restraint-related death...................................................................................................................................................37

Figure 2 Process of profound lactic acidosis.......................................................................................48

Figure 3 Continuum of risk in managing violence or aggression........................................................68

Figure 4 Multifactorial model of restraint-related deaths..................................................................69

Acknowledgements




The authors wish to thank the following for their contributions and advice:

Professor Richard Shepherd; Matt Leng (Ministerial Council on Deaths in Custody), Deborah Coles and Victoria McNally (INQUEST), Prof Richard Whittington, Malcolm Rae, Dr Brodie Patterson, Prof Ian Wall.
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