Restraint Reduction Policy
- Strategy 1: LEADERSHIP AND GOVERNANCE
The organisation develops an organisation wide plan designed to increase the quality of life for service recipients as well as reduce and minimise the use of restrictive interventions and restrictive practices. Such a systems approach should have review and planning mechanisms.
What is the main priority in this area:
The main priority is to ensure that the individual is safe and free from harm in the least restrictive way possible.
All plans are written and reviewed by a RMN with agreement from all professionals involved in the individuals care including but not limited to- Psychiatric team, LD team, SALT team, physiotherapists, family members, friends with the individual at the centre of everything we do. All instances that restraint is used will only be by trained care professionals who understand the individuals’ needs and rationale. Each time restraint is used this will be very clearly documented and reported to the MDT and reviewed to look for preventative measures or signs of escalation. There will be a protocol for each individual ie a Behavioural support plan that will give examples of how to deescalate specific situation and techniques that can be used including distraction techniques, music therapy, situation avoidance, sleep monitoring, regular checks on the environment to remove specific object that may cause harm to the individual especially in self-harm situations.
What we have done so far:
We work closely with the ICBs who commission the care to ensure that we receive as much information as possible prior to commencing the initial assessment. Once completed then we will review the details gathered and have regular discussions with the MDT about any restraint required to keep the individual safe, but it is agreed that restraint is always a last option and we actively review each and every time there is an incident that required restraint to look any signs of why it was required, what techniques where used to try to deescalate and also full disclosure of how the restraint was performed, body maps completed to evidence holds used as per training given.
What we plan to do next in this area:
Ongoing updates with our mental health team in least restrictive practice to ensure restraint is only ever used when all other options have been exhausted, and the individual is at risk of hurting themselves or other people. Ongoing training especially person-centred training for each individual that we support on best practice and what works best for the individual, this is reviewed regularly and updated with the team to ensure that the least amount of restraint is used.
- Strategy 2: USING DATA TO INFORM PRACTICE
The organisation uses data to identify, plan and review the overall organisation wide plan to reduce restrictive practice/interventions, improve service delivery and/or increase quality of life.
What is the main priority in this area:
The main priority is to review data to look for ways to prevent the need for restraint by using other techniques before escalating to restraint.
As well as weekly review of all incidents for the package this is also reviewed at our clinical governance meeting to discuss as a business the importance of restraint reduction and what is being done in each care package to ensure that less restraint is used.
What we have done so far:
We are constantly reviewing each incident and looking at the following areas- what was the build up to the incident, what techniques were utilised, could they have been used sooner to prevent further escalation, what restraint was used, by who, for how long, what happened afterwards and a body map. There is also a meeting with the staff involved to discuss the incident and why they felt it was necessary. All of this documentation is made available to the professionals within the individuals MDT.
What we plan to do next in this area:
We plan to work with health professionals and implement more positive behavioural support plans and to actively encourage not using restraint when possible, we will be sharing the amount of restraint used in a confidential way using statistics to evidence how well the staff are doing to reduce the amount of restraint. This will help staff to see the positive way forward.
- Strategy 3: STAFF TRAINING AND DEVELOPMENT
The organisation ensures that all members of its workforce have the knowledge and skills they require to implement improvement measures and prevent and respond sensitively to any behaviours of concern.
What is the main priority in this area:
That staff are adequately trained in the restraint that is allowed to be used for each individual as this varies so much. Training is an ongoing need for each and very staff member and as well as refreshers it’s important to have reflective meetings to review the current care package with them
What we have done so far:
All staff are trained in PMVA and also receive client specific training for each individual they support. They are also given extra training on top of mandatory training including but not limited to – behaviours that challenge, mental health training, suicide prevention, ligature training, breakaway training, supporting individuals who have suffered abuse, social inclusion training, sensory training, overstimulation training, routine management, least restrictive way of life.
What we plan to do next in this area:
Our training suit is growing every week and more and more training is added depending on the individuals needs or often how they present and the challenges that this may bring, we see training as a necessity of good practice and to enable an informed workforce to be able to manage more effectively and support the individuals in the least restrictive way to give them the best quality of life possible
- Strategy 4: PREVENTATIVE MEASURES AND PERSONALISED SUPPORT
The organisation ensures that staff have access to the tools they require to manage risks, to improve or enhance service delivery as well as personalise the support provided to people using the services.
What is the main priority in this area:
As all care packages are risk assessed the staff have digital access to all risk assessments completed, this includes Positive behavioural support plans and care plans and these are updated monthly or sooner as required. We are aiming to reduce the likelihood of risks to the lowest possible level in the least restrictive way.
What we have done so far:
By having a digital platform for risk assessments and care plans this means staff have the most recent up to date versions by logging into the app. As the package of care evolves improvements to risk ratings are reviewed monthly
What we plan to do next in this area:
Working with each individuals’ MDT we are always looking at ways to manage risk and to encourage positive risk taking in the least restrictive way possible, sometimes the use of distraction or diversion techniques are helpful and the insight from family into what works what does not, what triggers the individual may have as an example and how to avoid that.
- Strategy 5: INVOLVING THOSE WHO RECIEVE YOUR SERVICES
The organisation fully involves the people who use services in order to establish a clear understanding of their needs and to determine whether or not the service that is delivered meets their needs and expectations.
What is the main priority in this area:
For the individual to be at the centre of everything we do and for their voice to be heard. We always engage with the individual and ensure that they feel included as its their life their care and their future.
What we have done so far:
Even from the recruitment stage we involve the individual they can have an active part in the selection process, we can set up a second interview with the individual and we work with them to create questions they want to ask the candidate and then they can mark them before making a decision as to which candidate they think will be the right fit for them, then the next stage would be a face to face meet and greet, generally somewhere public where possible and it is less intrusive, the park or a cafe and spending some time getting to know one another. Then there will be shadow shifts where new staff can attend to do a shadow with another staff member of family member again with the individual at the centre of everything we do. The care plans are written by them, we document the hopes/wishes aspirations and can even set goals up so the staff know what they are working towards and once achieved a new goal can be set.
What we plan to do next in this area:
Always improving, we never stop learning and evolving but we always do it extremely client focused and in the least restrictive way possible to ensure the client is able to live a fulfilled life
- Strategy 6: CONTINUOUS IMPROVEMENT
The organisation adopts a culture of reflection and positive learning in order to ensure the necessary change can be embedded and implemented at service level, through the workforce scheme of working as well finding its way into everyday interactions between staff and people using the services.
What is the main priority in this area:
We are always asking for feedback from staff, individuals and the family and also the MDT and we are very open to change. We want to be able to provide the best possible service to the individual.
What we have done so far:
Airmid staffing does conduct regular surveys to both staff and individuals to get their feedback on what is working what is not working and what could be improved, and we take the outcome and review this at our governance meetings each month and we implement change when required.
What we plan to do next in this area:
We have a close bond with all of the individuals that we support and as we encourage feedback regardless of whether it is positive or negative as it allows us to review our service and improve it.
Our top priorities for the next 2 years and measures of success:
- Priority 1:
Education is key to change, therefore for each individual care package that we have we aim to give a person-centred induction to each new staff member to ensure that everyone involved in the individuals care is aware of de-escalation techniques and sign of escalation, signs to look out for and to always be doing everything in the least restrictive way possible.
Each incident of restraint will be carefully documented and reviewed so that we can look for more signs of escalation to help in the knowledge and education to only use restraint when everything else has not worked and the person is at risk of harming themselves or those around them.
Measure of Success:
At the monthly review meeting each instance of restraint will be reviewed to look at what worked and what did not and to look for trends in escalation, the measure of success will be in there being less need to restraint and less instances, The more education the and knowledge the staff have the easier it will make their roles and also the individual will know they are in safe hands.
- Priority 2:
The use of reduction tools and strategies and integral to the person-centred approach to managing individual packages of care and we want to get it right for the individual and for them to be happy and feel safe.
Measure of Success:
The measure of success will always be that restraint used is minimal and only once all other instances have been explored.
- Priority 3:
The data is so important as it allows us to review each care package on a case by case scenario. We will always review data and conduct improvements and share ideas with colleagues and professionals for advice.
Measure of Success:
To have the least amount of restraint used on an individual. The data allows us to review what is working what is not and it allows for change. We want to ensure every individual always receives the right level of care.