Embed Size (px)
Citation preview
Ensuring Harmony, not Harm
Steve Garvey
Patient Handling Trainer
Worcestershire Health and Care NHS Trust
Ensuring Harmony, not Harm
Exploring the implications of
Positive and Proactive Care
and measures aimed at
reducing the use of restraint, within
Worcestershire Health and Care NHS Trust
Services within Worcestershire Health and Care NHS Trust
Adult Mental HealthProvides community and inpatient services to adults with Mental Health needs
across Worcestershire. There are four adult and two older adult mental health in-patient wards.
Children, Young People and FamiliesProvides paediatric and mental health services for children, young people and
their families across Worcestershire.
The Patient Handling Team also works with the CAMHS Team to provide support and guidance to families where the child’s/young person’s behaviour
presents risk.
Services within Worcestershire Health and Care NHS Trust
Community CareProvides inpatient, outpatient and community care on a locality basis to adults
and older adults across Worcestershire.
Learning DisabilitiesProvides adult and children’s respite, outpatient and community contact activity
for people with Learning Disabilities and their families.
The implications of Positive and Safe are far-reaching and we’re finding layers of questions as we go along.
This is an opportunity to consider where we are, where we’re going and the role the MAPA Ambassador can play
in supporting improvements to practice.
Following the publication of the Positive and Proactive guidance:
• Advisory Paper prepared and presented to the Clinical Governance Sub-Committee.
• Lead nominated by CGSC to coordinate and direct the Trust’s response to Positive & Proactive and to ensure compliance.
• Reducing Restrictive Interventions Project Group established, involving In-Patient unit managers, Senior Managers, Patient Safety Manager, Psychology Team members, Patient Handling Team and various other specialities.
• Process and objectives linked to CQUIN funding, so a Project Plan and timescales were established.
The Reducing Restrictive Interventions Project is very much a work inprogress and will continue to be so - it’s a journey…
• Key elements
• Data collection and reporting – Patient Safety Team
• Refining the Trust’s online reporting system to make it ‘work’.
• Reinforcing, with staff, the need for accurate reporting.
• Improving patient care through positive behaviour support – Safewards.
• Reviewing and updating approaches to care planning – ‘behaviours which challenge’.
Implications for practice – we need to:• Avoid prone restraint, so staff have had to adapt their thinking.
• Achieve and evidence a reduction in the use of all forms of RI.
• Evidence that proactive interventions are contributing to that reduction.
• Patient choice….
Implications for training:• Focus on and promote the principles within the P&P guidance.
• We still need to teach descent to prone and prone interventions on the floor / bed, to enable staff to safely manage when the patient creates that situation.
• Use of alternative sites for administering IM medication – Rapid Tranquilisation.
Other implications:
• Need to improve standard of reporting.
• Reporting of prone restraints – encourage staff – ‘fear of reporting’ prone restraint.
• Definitions
• Updating of Trust Policy to include principles of P&P and the updated MHA CoP
• Need to improve approaches to debriefing and evidence learning from incidents.
MAPA Ambassadors – and their role:
• Meetings with Patient Handling Team
• Minutes distributed to managers
• High Impact Actions initiative – highlights the issues and gives added status to the MAPA Ambassadors.
• The role of the MAPA Ambassador:
Direct link to the Patient Handling Team – communication; problem-solving; promoting best practice.
Promote the underpinning values and philosophy of MAPA, within their own work base / unit;
Constructively challenge ‘custom and practice’ in the workplace, to encourage everyone to question and improve how they support and interact with patients;
Support the introduction and implementation of the ‘Positive and Proactive Care’ guidance, in the workplace;
Support the introduction and implementation of the ‘Safewards’ concept to the management of patients’ behaviours.
Contribute to the development of more proactive interventions, relating to the specific needs of individual patients.
• Results / progress so far……..
• What do we have to show for all of this work?
• What conclusions can we draw from the information we have so far?
0
100
200
300
400
500
600
700
Overall PICU Harvington Hill Crest Holt Athelon New Haven
628
182
112
84
52
18
145
442
141
6277
49
25
68
Annual Totals of restrictive physical interventions by unit
Sep 13 - Aug 14 Sep 14 - Aug 15
48
68
5356
26
43
48
53
63
46
72
5248
54
2830
37 37
62
25
30
23
46
22
0
20
40
60
80
100
120
140
Total Levels of Restrictive Interventions - All Areas
15
21
18
12
7
1516
24
17
5
20
12
18
98
5
8
11
32
12 12
4
19
3
7
10
17
7
2
8
10
6 6
14
18
7
1
7 7
4
13
8
45
10
7
5
7
5
23
8
43
5
7
9
22
9
14
24
56
23
2 2
10
4 4
1
0
5
10
15
20
25
30
35
Adult Mental Health - Total Levels of Restrictive Interventions
PICU Harvington Ward Hill Crest Ward Holt Ward
5
0
3
0
2 21
0
21
0
2
0
3
0
6
3
1
11
0 0 01
0
6
16
6
30
3
1112 12
21
15
76
8
5
3
54
9
5
1 1
9
6
12
0
5
10
15
20
25
30
35
Community Care North - Total Levels of Restrictive Interventions
Athelon Ward New Haven Ward
6 6
8
5
3 3
2
6
8
1
10
6
4
1
0
1 1
0
1
0
1
0 0 0
2
0
3
2
0 0
1 1
0
1 1
0 0 0
1
2
1
0 0 0 0 0 0 00 0
1
2 2 2
0
1
2
0
15
3
4
3
0 0 0 0
2
0 0 0 0 0
1
4
0 0 0 0 0 0 0 0
1 1
0
2
0 0 0 0 0 0 0 0 0 0
0
2
4
6
8
10
12
14
16
18
20
Adult Mental Health - Prone Restraint Totals
PICU Harvington Ward Hill Crest Ward Holt Ward
1
0 0 0
1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0
1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
1
2
3
4
5
Community Care North - Prone Restraint Totals
Athelon Ward New Haven Ward
• What other indicators should we should be monitoring?
• We need to encourage staff to report ‘near misses’ – occasions when they have successfully avoided the need for restrictive interventions.
• We also need to recognise and celebrate good practice within our teams.
What next?
A formal, structured, Restraint Reduction Programme,
to build on the work done so far.
Monitor progress to identify where there may be any learning needs.
Recognise and support positive practice – in ways that will improve patient care and provide evidence, to CQC, of compliance with
Positive and Proactive Care.
Thank you
Ensuring Harmony, not Harm
Steve GarveyPatient Handling Trainer
Worcestershire Health and Care NHS Trust
Training and Development Unit
Email: [email protected]
Contact: 01905 681682 / 681741
Mob: 07918 769061
Additional data
4
5
8
4
1
6
8
3
5
2
7
4
6
4
5
4 4
8
12
7
9
2
12
2
5
6
5
3
2 2
4
3 3
10
7
1 1
0
2
1
5
7
3
2
1
0
7
5
4
2
1
0
1 1
2
0
3
5 5
6
8
13
3
6
1
2
0
2 2
3
2
1
2
5
1 1 1
0 0
4
0 0
2
5
2
1 1
2
4
3
2
4
2 2
4
1
0
5
10
15
20
25
Adult Mental Health - Seated & Standing Interventions
PICU Harvington Ward Hill Crest Ward Holt Ward
3
0
2
01
01
0
21
01
0
2
0
5
21
8
0 0 01
0
6
13
1
19
2
8 89
16
13
5 5 5
3 34
3
9
5
1 1
9
4
12
0
5
10
15
20
25
30
35
40
45
50
Community Care North - Seated & Standing Interventions
Athelon Ward New Haven Ward
1
2
0 0 0
4 4
12
2
1
3
1
6
3 3
0
1
2
3
1 1
2
5
00
1
0 0 0 0 0
1 1
2
5
1
0
1
0 0 0
1 1
3
0 0 0 00 0 0 0
2
1
0 0
1
0
2
0 0
3
0 0 0 0 0 0
4
0 0 0
0
1
0 0 0
1
0
1
2
0 0
8
3
0
1
2
0 0
2
0
1 1
0 00
2
4
6
8
10
12
14
Adult Mental Health - Supine Interventions
PICU Harvington Ward Hill Crest Ward Holt Ward
0 0 0 0 0 0 0 0 0 0 0
1
0
1
0 0
1
0
1
0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00
1
2
3
4
5
6
7
8
9
10
Community Care North - Supine Interventions
Athelon Ward New Haven
0 0 0 0 0 0 0 0 0
2
0
16
3
0 01
00 0 0 0 0 0 01 1
5
0 0 0 0 0 0 00 0 0 0 0 0 0
2
01 1
0 0
3
12
00 0 0 0 0 0 0 0 01
0
21 1 1
2
0
0
5
10
15
20
25
30
35
40
45
50
Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15
Adult Mental Health - Episodes of Side-lying Interventions
PICU Harvington Ward Hill Crest Ward Holt Ward
0 0 0 0 0 0 0 0
1
0 0
1
0 0 0 0 00 0 0 0 0 0 0 0 0
1
0 0 0 0 0 0 00
1
2
3
4
5
6
7
8
9
10
Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15
Community Care North - Episodes of Side-lying Interventions
Athelon Ward New Haven Ward
![[XLS] · Web view4/14/1987 3/4/1991 0 94 94 10/1/1995 4/14/1997 0 1 4/14/1987 3/4/1991 0 94 94 10/1/1995 4/14/1997 0 1 4/14/1987 3/4/1991 0 94 94 10/1/1995 4/14/1997 0 1 4/14/1987](https://img.pdfslide.us/doc/110x75/5b43abbd7f8b9a64608b58c8/xls-web-view4141987-341991-0-94-94-1011995-4141997-0-1-4141987-341991.jpg)
![[XLS] · Web view19347 2009 13 1464 0 0 0 1464 2009 13-128 0 0 0-128 2009 14 332 24 1 8 0 33 2009 14 333 18531 486 2988 0 22005 2009 14 326 76 2 8 0 85 2009 14 2514 0 0 0 2514 2009](https://img.pdfslide.us/doc/110x75/5ad7bbd97f8b9a5b538d0383/xls-view19347-2009-13-1464-0-0-0-1464-2009-13-128-0-0-0-128-2009-14-332-24-1-8.jpg)
