lowed in the deprivation of liberty. The main results of the visit are to be discussed in a final talk with the head of the facility. So far, almost all visits by the National Agency have given rise to a number of recommendations for improvements in the accommodation and treatment of the persons held, in some cases against the background of unacceptable shortcomings. A detailed list of the recommendations and of the reactions of the supervisory authorities as to their implementation can be found in Part IV of this report. 3 Regularly recurring recommendations and examples of best practice The National Agency repeatedly came across a number of critical determinations in its inspections. These are summarised below, and the position of the National Agency on the individual topics is described. Furthermore, particularly successful practical examples of individual facilities are to be put forward in order to help bring about an exchange of such exemplary practice. 3.1 Fixation Fixation should only be ordered as the last resort and subject to unambiguous, strict preconditions, and should be restricted to the shortest time possible. The use of belt/bandage systems is recommended in order to implement fixation in a way that causes as little damage as possible. Metal devices should always be avoided because of the high risk of injury. In order to respect the sense of shame, any investigation of the individual cases should clarify the question of whether complete or partial re-dressing takes place with suitable clothing which is provided separately for this. Complete undressing and clothing only with provided underpants as a standard measure is undignified and indecent. In addition to constant, direct observation by officers of the person who has been fixed (direct supervision by an officer), the person concerned should be subjected to regular medical checks. Comprehensible written documentation of the entire fixation procedure must be produced in each instance of fixation. In the Ochsenzoll North Asklepios Clinic in Hamburg, further training courses are offered to staff within the clinic on de-escalation measures in which they are trained in appropriate dialogue techniques and on how to deal with fixation sensitively. It is likely that the officers’ own experience was particularly helpful here, given that they themselves were bandaged in order to be able to understand the fixation situation. Additionally, the internal differentiation concept, which is used in one wing, should be stressed, which helps to considerably reduce the 20