HdBe-FreedomRestrictingIntervention

Freedom restricting interventions are interventions that are used against the will of the person concerned and that consciously restrict the person's freedom to protect the person or his environment. This definition includes many forms of freedom restriction, such as (not exhaustive)

• Forced administration of fluid and nutrition
• Forced administration of medication
• Performing medical checks or other medical procedures
• Restricting freedom of movement
• Admitting to an accommodation and secluding when admitted to an accommodation.
• Exercising supervision
• Searching of clothing or body
• Restriction of visitors and the use of communication means

In the hospital, it is usually about restricting the freedom of movement, for example by using bed rails, moving a chair near to the table or using an arm splint for infusion. In combination with freedom-restricting interventions, soothing medication can be administered. In the case of small children, it is often a question of fixing hands, for example, to prevent a stomach tube from being pulled out. For nurses to use it in hospitals, Dutch Nurses Association (V&VN) published a guideline [ref. 3]. In mental health care, care for the disabled and psychogeriatric care, it always concerns care that is used against the will of the patient. The legal framework for using these interventions is (per 1-1-2020) governed by two laws, namely:

• The Wet verplichte ggz (Wvggz: Mandatory Care In Mental Health Act) for people with psychiatric disorders
• The Wet zorg en dwang (Wzd : Care and Compulsion Act) for people with intellectual disabilities and people with a psychogeriatric disorder, such as dementia.

The Wvggz refers to the term compulsory care, while the Wzd uses the term involuntary care. A national registration system, the Argus registration, is used to register the interventions in the context of the Wvggz.

Purpose

Freedom-restricting interventions (also called involuntary / compulsory care) are applied to prevent or limit serious harm to the person concerned or others or to stabilize or restore the mental health of the person concerned. Implementing freedom-restricting interventions is risky and can result in damage to the the person concerned if they are not carefully implemented. Health professionals fulfill an important role in identifying risks, observing the effect of the interventions and any changes to the policy in terms of involuntary/compulsory care. Recording all information on the interventions is of major importance for insight into decision-making, implementing, monitoring and evaluating the freedom-restricting interventions. The reporting of applied freedom-restricting interventions is also part of the set of quality indicators of the Healthcare and Youth Care Inspectorate

Evidence Base

The Freedom-Restricting Intervention information model applies to both care in the hospital environment and to mental and disabled care and psychogeriatric care. The reason for the revision of the information model is the fact that the Special Admissions for Psychiatric Hospitals Act (Bopz), on which the building block was partly based, will be replaced in January 2020 by two new laws, ie:

• The Wet verplichte ggz (Wvggz) for people with psychiatric disorders
• The Wet zorg en dwang (Wzd) for people with intellectual disabilities and people with a psychogeriatric disorder, such as dementia.

The new laws make new demands on what information is recorded. In the situations where the two above-mentioned laws apply, the information model is only applied when there is involuntary/compulsory care. That is why it is not recorded whether there has been resistance and to what extent. Restrictions imposed on a voluntary basis - apart from a number of exceptions described in the law - are regarded as regular care and can be recorded with the appropriate information models. Deciding whether involuntary / compulsory care is involved falls outside the scope of the building block. The information model provides a start and end time for recording time registration. The last element is not relevant for all interventions: some interventions are momentary and not duration registrations.The information model offers the possibility to register a start and end time. The last element is not relevant for all interventions: some interventions are momentary and not duration registrations. In this version the information model includes new value lists with interventions based on the aforementioned laws. Although is was attempted to achieve far-reaching harmonization in defining the interventions, it was nevertheless decided to make three separate lists for the different situations in order to simplify the correct application. The situations mentioned simply require other interventions.

Issues At the time of making this version of the information model, a number of legal texts and elaborations thereof in the aforementioned regulations were only available as a draft versions. The information reflects the situation at the end of October 2019. Any changes after this date will be processed in subsequent versions. Final references, such as to the Argus 2.0 registration, will also become available in later versions.