Defining chemical restraint: A preliminary step towards measurement and quality assessment

Abstract

Aggressive and violent behaviours often lead to the use of coercive interventions in health and forensic institutions. Restraint minimization is now a legal or governmental requirement in most jurisdictions. While physical restraint and seclusion are relatively well-understood, chemical restraint remains problematic to define and measure. The aim of this review is to explore the international understandings of chemical restraint and to formulate an operational definition to support the development of quality indicators and care standards. This review was the first step prior to a realist synthesis to clarify the scope of chemical restraint intervention. PRISMA extension for Scoping Review was used. A keyword-based literature review (2006–2020, French and English) was conducted in health and social science databases. Chemical restraint or sedation of behavioural symptoms involves an emergency (STAT), as needed (PRN), regular or continuous medication with sedative properties, administered with the intention of preventing or controlling harmful behaviours or behaviours that interfere with diagnostic or therapeutic interventions, AND/OR administered to avoid physical restraint or seclusion; AND/OR without the person's consent. This first operational definition of chemical restraint could support the development of quality indicators in addition to allowing initiatives to improve health outcomes, safety and promote person-centred care.