Annual Report 2012: Spain’s National Preventive Mechanism consent, when there exists «a serious immediate risk for the patient’s physical or psychological integrity and his/her consent cannot be obtained»; however, there is no specific mention or reference to physical or pharmacological restraints. Nonetheless, the Social Services laws of some autonomous regions do establish the right of users of Social Services to not be subjected to any kind of immobiliza­ tion or physical and pharmacological restraint without a medical prescription and supervision, unless there exists imminent danger for the user’s physical safe­ ty and that of third parties. As a safeguard for users, these laws require docu­ mented justification for said actions, that they be recorded in the user’s file and that the Public Prosecutor’s Office be notified. The use of physical and In consequence, it is essential to clearly and concisely regulate the concept of pharmacological restraints restraint at a national level, together with the cases in which restraint can be must be regulated in a clear and precise manner applied, proportionality and suitability of the means used, the time the measure is to last, authorization for application of the measure, documenta­ tion of measures taken, assessment of the effects and results, and all necessary guarantees. Residential centers must aim at reducing the use of restraints 199. Moreover, centers should aim at reducing the use of restraints. This could be achieved, for example, by encouraging residents to move around with mobili­ zation and «fitness walking» programs to prevent loss of mobility, or by means of greater control by the assistant nursing staff to prevent falls. Likewise, the use of restraints that only limit a patient’s mobility to the extent required should be given priority (for example, non-skid harnesses instead of belts). The Protocol on the use of During the inspection visit it was noted that in general terms the «San José» Res­ restraints must be updated idence tried to minimize the use of restraint and to use them in any case follow­ to unify guidelines and ensure that the rights of ing medical criteria, and not as punishment. The physician asks the relatives to individual residents are authorize the measure in writing and fills out the form prescribing restraint, guaranteed at all times which is not subsequently modified or updated if the conditions that motivated immobilization do not change. The physician prescribes physical restraint and day to day application is carried out by the nursing staff following the medical order. Even though use of restraints is and subject to strict medical criteria of the physician in charge in each building, the medical personnel interviewed ac­ knowledged that some of the restraints could be avoided by having more assistant nursing staff and with mobilization and walking programs. The center’s manage­ ment should update the «Protocol on the Use of Restraints» in order to unify guidelines in this matter, subject at all times to guarantees for the rights of indi­ vidual residents. 146 THE OMBUDSMAN OF SPAIN