The National MS Centre aims to provide comprehensive and safe care for every patient, this sometimes requires a difficult trade-off between autonomy and patient safety. Therefore, coercive measures are only used as a means of last resort, as the 'least bad' solution to an otherwise unsafe situation. This means when the safety of the patient and/or others is at risk and cannot be guaranteed in any other way.
Thus, specific alternatives such as raised supervision, bed in lowest position and wearing hip protectors are applied initially. Adequate cognitive and sensory stimulation is provided such as the provision of a newspaper, a clock, a calendar and attention to the correct use of glasses and hearing aids. Furthermore, we also strive for individualised care, which creates a climate of trust with and around the patient.
If, despite these efforts, the physical or psychological integrity of the patient or others is compromised or there is a risk of interruption of vital therapy, coercive measures may be used.
The use of freedom-restricting measures is always done in consultation with the doctor and is organised as briefly and as comfortably as possible for the patient. Increased supervision is provided during these measures, so that extra attention is paid to the patient's basic needs, and attempts are made to guide and support the patient.
For example, physical restraint may be used if necessary. This includes 'any action or use of material that restricts freedom of movement and cannot be easily removed'. An example is bed rails.
The use of seclusion or isolation (there are no isolation rooms) and coercive medication (administering medication against the patient's will for therapeutic reasons) does not occur at NMSC.
The healthcare provider implementing coercive measures must always be able to motivate this to the patient, his family and other healthcare providers. The necessity of the coercive measures should be continuously evaluated throughout their application.