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In such cases, restraint may be used to compel compliance with medical procedures or to prevent a person causing harm to themselves.
We would not use restraint to enforce compliance with a medical procedure. The reason for this is very simple: even if a person who lacks capacity to make decisions were to need dental treatment that was clearly in their best interests but they were resisting such treatment, we would not be able to provide that treatment. This is because an uncooperative patient could not realistically undergo significant dental treatment unless they had first been sedated or placed under a general anaesthetic (GA). We do not and cannot perform sedation or GA at the practice since it is not considered an appropriate setting for such treatment to take place. Any such cases would, therefore, be referred to an appropriate setting such as the Community Dental Service or Hospital Dental Services.
Accordingly, our restraint policy is concerned with the prevention of harm to patients (and possibly to team members) in the sorts of circumstances set out below. As will become clear from the examples, such cases could equally well involve persons who have capacity to make decisions as those who lack it. The principles that govern restraint are set out: (i) in relation to persons who lack capacity, in the Mental Capacity Act 2005 and the associated code of practice, and (ii) in relation to persons who have capacity, principally by the common law governing self defence and the prevention of crime. The principles in each situation are broadly the same and so the procedures set out below apply equally to all patients:
A patient who grabs a practitioner’s hand during treatment
It is not uncommon for a nervous patient to reach out and grab the practitioner’s hand (or the instrument they are holding). This may occur, for example, when the dentist is about to administer an injection or a practitioner is about to apply a dental bur in a dental handpiece to one of the patient’s teeth and the patient has a sudden, brief moment of panic.
In practice, where this happens it is highly likely that words of reassurance will suffice to calm the patient and avert a potentially hazardous situation.
However, where reassurance does not suffice or it is necessary to act swiftly to avoid harm, it is entirely appropriate for a team member to use mild to moderate force to remove the patient’s hand(s) from them or to restrict the patient’s movement. This may be essential to prevent the patient unwittingly stabbing themselves or the team member with a sharp object. Only the minimum force necessary should be applied and only for so long as it takes to remove any dangerous objects from the patient’s reach. The team member should cease to apply any force at all and disengage from the patient as soon as this has been achieved and any immediate danger of harm to the team member or the patient has passed.
A patient who becomes violent or threatens violence
This has not been an issue at any time since Dr Giddy and Mr Phillips took on responsibility for the practice in 1998 – more than 17 years ago. Nonetheless, it is a possibility.
Should a patient become violent or threaten violence, the first course of action should always be to use calm and calming words and actions in an effort to diffuse the situation.
Where this fails, the next option is retreat – to remove oneself and others from the potentially dangerous situation.
Only where efforts to diffuse the situation fail and retreat is not possible or practical, a team member may use reasonable force to defend themselves or others from violence by restraining an assailant. This is a last resort and should only be done where all other options have been exhausted. The police must be summoned and any restraint should only be maintained for the briefest possible time.
Any such incidents must be recorded in the accident and incident report book which is kept at reception: notes should be handwritten by someone who was a witness to the incident and should include the date, time and location of the incident; the names of all the persons present; a description of exactly what happened: who said what, who did what; details of any police attendance (including a crime reference number, if any); ending with the date and time the note was made and the reporting person’s signature.
The incident will be reviewed by Dr Giddy and Mr Phillips, who will consider whether any lessons can be learned and (i) whether any changes to policies and procedures should be made; and (ii) whether any additional training is required.
Web version 1: 6.11.2014 (reviewed 5.6.2015; 3.8.2016)