Framework for assessment of restraints and coercive

methods in healthcare and social care

Eve Pilt and Jooske Vos

Short History 1

• Paris -April 2012

start of EPSO working group:

Presentation by Estonia: ‘Restraints in nursing care. How to improve working methods?’

Other EPSO-members were asked to join the working group

Short History 2

• After Paris – before Utrecht

The EPSO working group was formed by Estonia, Flanders, IGZ and Vilans Netherlands, Northern Ireland and Denmark and EPSO secretariat

Group started with

a. Discussion on scope and purpose,

b. Formulating the questionnaire on restraints and coercive methods,

c. comparative study between EPSO members.

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Short History 3• Utrecht

Presentation of results of comparative study between EPSO members;

Discussion about follow up; Working group was asked to continue and prepare for a broadening of the discussion on this topic.

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Short History 4• After Utrecht

Working group broadened scope by introducing:

-Epso assessment framework (first draft) incl. :

a. organizational context to deliver good and adequate supervision on restraints and coercive methods;

b. minimum standards for health care providers;

-CPT standards (second draft) including Human Rights aspects on using restraints from CPT standards as an added value.

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What is the aim of this Assessment framework?

For supervisory or monitoring organisations :

•Introduction of a broad definition of using restraints within the European legal context

•an organizational context;

•useful tool: set of criteria including minimum standards for healthcare providers

broad definition

For supervisory or monitoring organisations :

•Introduction of a broad definition of restraints within the European legal context including:

Physical /Mechanical / Chemical,

Technological and Psychosocial force.

Organisational context

Introduction of a set of checkpoints / criteria regarding

organisational aspects for supervisory or monitoring organisations

Useful tool/ Set of criteria

For supervisory or monitoring organisations introduction of a set criteria:

minimum standards for healthcare providers including standards derived from healthcare relevant CPT standards

Criteria for supervisory and monitoring organisation

• Independence• Unlimited access to accommodations and

documents and patients with their consent;• Provides solicited and unsolicited advice

on using CPM and on alternatives to CPM• Has in its disposal sufficient enforcement

measures• Reports publicly on deficiencies in law and

other relevant deficiencies

Contributing to raising awareness

• Is involved in raising awareness among health care providers;

• Prompts government on the results of their work and initiates changes in the law or in practice if needed

Minimum standards for health care providers

• Has clear vision and policy on using and/or preventing using of RCM based on broad definition on using restraitns

• Works systematical with instructions and protocols

• Has a register on using restraints and the cases documented inclient files

• Exercises regular problem analysis of client cases

Minimum standards for health care providers

• Provides that decision on using restraints is issued by a person authorised according to relevant country law and preferably made by multidisciplinary team ;

• Obtains consent from a patient or the legal representative;

• Makes sure that qualified staff is available;• Stops using restraints asap;

What does qualified staff mean?

• Qualified staff knows how to:

- Use the least restrictive methods first;

- Are capable of applying de-escalation techniques;

- Are aware and trained in how to prevent using CPM;

- Are aware and trained in using alternative methods to reduce the need for CPM ;

Qualified staff and human rights

Management makes sure that:

- Honouring human rights is ordinary part of everyday routine;

- The staff is aware of CPT standards on using restraints in psychiatric settings and understands their relevance in other health care settings.

How to proceed further? (1) fine-tuning the framework

• Discussion in Brussels 18-04-2013

• EPSO members are asked to give comments on the content of the framework and sent to EPSO before august 2013;

How to proceed further? (2) Pilot ?

• Which EPSO member wants to volunteer to a pilot with this Assessment framework?

• If so a of pilot project will start in one or more countries.

How to proceed further? (3) After the pilot

• Discussion in EPSO context ( one of the next conferences)

• Amendments to the framework based on the results of the pilot project.

• Final framework sent to all EPSo members for last comments

How to proceed further? (4) after a pilot

• Communicating the final framework to governments, service providers and other interested parties.

(as a useful tool to improve procedures and results in handling restraints in health care and social care)