Framework for Clinical Holding

Synopsis of the literature

2008 RCN guidelines “Lets talk about Restraint” - although past review date this document on page 9 suggests through 3 case studies that the following questions should be considered…

if restraint (clinical holding) is used it should be…

  • the least restrictive option
  • as safe as possible
  • for as short a time as possible
What does this mean? How can/do you currently evidence this? Who decides?

2013 RCN Dignity in Healthcare for people with a learning disability offered using sedation as an example of good practice (p7).

2017 DoH Reducing the need for Restraint and Restrictive Intervention… discusses whether individuals should be restrained - i.e. page 40/41.

2018 University of Bristol CIPOLD (Confidential Inquiry into Premature of People with a Learning Disability), identified (p7) that problems with routine diagnosis and treatment has been identified as a common reason for premature deaths.

Public Health England Blood tests for people with learning disabilities: making reasonable adjustments (2017)

  • Clinical holding should be used as infrequently as possible and only when all other approaches have been tried or considered (page 8).
  • Clinical holding must be underpinned by an ethos of caring and a respect for the individual’s rights (page 9).
  • There should be a risk/benefit assessment prior to the intervention - this should include careful consideration of whether the procedure is necessary and if there are any alternatives to clinical holding.
  • There must be a sufficient number of staff who are appropriately trained and confident in the process.
  • Accurate record keeping is essential - this should include why the intervention was necessary and details of what it involved
How can/do you currently evidence this? Who decides?


There are no clear documentation, articles, frameworks or total agreement about the clinical holding of children, young people or adults for procedures. Therefore we have developed the following framework to help you with planning, decision making and documentation to support clinical holding techniques.

Introducing the Framework

This framework should be used for any hold that you use in practice and it’s a great way of talking to the patient, carers/parents, students/apprentices, etc., about preferences for holding and a useful means to help with documentation

Intro and approach, including consent.
Any concerns?

Procedure being performed

Purpose and benefit of hold

Characteristics of hold

Evaluation of Risk factors and action taken

Number of people required to apply this technique and their roles

How many attempts will be made?

When and why would you stop the procedure?

We know from our research and experiences, and it has been identified by colleagues in other countries, that holding is not mentioned in documentation (apart from some countries such as Turkey requiring parents signatures). This is because clinical holding regardless of what terminology is used is not regulated in any country. We can only refer to our professional codes, ethical frameworks and the international rights of the child to guide our practices.

Download the Framework for Clinical Holding (PDF)

Key considerations

  • Knowledge of anatomy and physiology and how the body moves
  • The procedure being performed
  • Purpose and benefit of the hold?
  • Characteristics of the hold?
  • Evaluation of risk factors and actions taken?
  • Number of people required to apply this technique and their roles?
  • How many attempts will be made?
  • When and why you would stop the procedure
  • The patients/parent preference?
  • Consent or best interests?

Evaluation of the clinical hold

  • Do I feel satisfied with my care delivery?
  • Could I justify my decisions to a 3rd party?
  • If I was repeating this care, would I do anything differently, and if so, what would this be?
  • How flexible have I been in my decision making?
  • Using the Clinical Holding website enables the user to document and reference the holding technique as well as the procedure or clinical intervention.



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