CALM (CRISIS AND AGGRESSION LIMITATION MANAGEMENT) TRAINING AND PRACTICE

Transcription

1 CALM (CRISIS AND AGGRESSION LIMITATION MANAGEMENT) TRAINING AND PRACTICE INTRODUCTION This guidance provides an overview regarding the training and practice of CALM within Fife Learning Disabilities Service in NHS Fife. Its guidance is to ensure that the implementation of CALM remains person centred and service specific. The aim of this guidance is to enable staff to use such strategies in line with NHS Fife's values and current legal requirements. WHAT IS CALM CALM stands for Crisis & Aggression Limitation Management. CALM Training Services was established in 1997 and is based near Stirling in Scotland. CALM Instructors are trained in all the interventions and are qualified to train other staff. CALM is accredited by the British Institute of Learning Disability (BILD) on behalf of the Department of Health and the Department of Education and Skills. CALM is a research based model which is heavily evaluated and audited. Fife Learning Disabilities Services at Lynebank Hospital and Hill Street Project were awarded the CALM Training Quality Assurance Certificate, providing evidence that Fife Learning Disabilities Services now meets the standards of the BILD Physical Intervention accreditation Scheme. There are two main categories of Physical Intervention techniques: Physical Interventions and Escape Techniques. The Physical Interventions range from low level, single staff interventions used to guide or direct an individual, to high tariff interventions which involve 2 or more staff, and are used to restrict an individual s movements and restrain them, either on the floor or on a chair. Escape Techniques are for use by single staff members to allow them to break away from holds such as hair-pulls, clothing grabs, and choke holds, and to create a distance between staff and the individual. HOW CALM IS CURRENTLY USED IN NHS FIFE Physical Interventions are only taught to the needs specific of our current patient group. All staff are expected to do the full menu unless staff are restricted due to health reasons.

2 A risk assessment is carried out in order to inform the decision as to which Physical Interventions will need to be used or not. This should be reviewed on a regular basis. All Physical Interventions used must be recorded. Ward staff are responsible for completing a Record of Restrictive Intervention form and Incident/Near Miss Reporting form. Incident/Near Miss Reporting forms are recorded as part of the DATIX system. Restrictive Interventions should only be used for individuals when Restrictive Intervention Management Plans have been completed by the Multi- Disciplinary Team, and only when that person or their representative has been informed (this is a legal requirement). Restrictive Intervention Management Plans should be written as soon as possible after admission. These are reviewed on a regular basis by ward staff and by a CALM Instructor. A Health Risk Assessment Form should be completed pre-admission, or within 24 hours of admission by the nurse in charge of the ward. Health Risk assessment form is designed to highlight any health related issues patients may have on admission to hospital. If restrictive interventions are required, the completed form should clearly indicate which physical intervention techniques should not be used. There are currently 4 CALM Instructors within the Fife Learning Disabilities Service, including the CALM Training Co-ordinator. Each instructor has been trained by CALM training services and is required to attend Re-accreditation on an annual basis. Re-accreditation involves assessment of the instructor s ability to perform each technique and their ability to teach it to others. The 4 CALM Instructors meet regularly to practise interventions, update knowledge and review current practice TRAINING IN CALM PHYSICAL INTERVENTIONS Health Checks all staff are required to sign a health form, stating that they are fit and able to participate in the training. If they are in any doubts regarding their fitness or health, this should first be discussed with their Manager and then if necessary their G.P or OHSAS. If staff tick yes to any health issue on the form then they MUST get a GP letter or from OHSAS indicating that they are fit to participate. 1. Training The risk calculator below has been used to identify the level of training that staff groups require.

3 Score Description Risk Level 1-3 The risk level is broadly acceptable Low 4-6 The risk requires monitoring and managing Medium 8-12 The risk requires action to be taken High The risk requires action as a matter of urgency Very High Staff Group score Course Duration and Frequency Community Nurses, Community OT s Psychologists, Allied Health Professionals, Porters, Domestics, Estates staff, Reception staff, Finance staff and Secretaries. Ward based staff, Hill Street staff and Behaviour support staff. Score 4-6 Score Crisis Intervention Awareness. CALM Theory in the management of challenging behaviour. ½ day every 3 years. ( is planned to be made available via Learnpro soon. 2 Full days every 3 years Ward based Nurses and Occupational Therapists Score Ward based Nurses, Behaviour Support Staff Score Occupational Therapists Hill Street Staff Score Practical Physical Interventions Training Escape Techniques and role play Escape Techniques 2 days annually and 3 updates annually. 2 days annually and 3 updates annually. 1/2 day annual accreditation. 3 updates per year Crisis Intervention Awareness. This course consists of CALM Theory, and does not involve any intervention or escapes training, but focuses instead on the assault cycle, de-escalation, safety awareness and the legislative framework. Before participating in CALM Physical Intervention training all staff must have attended the 2 day CALM theory in the management of challenging behaviour course.

4 Staff will be expected to demonstrate all of the techniques in the CALM Curriculum unless there is a prior agreement with their Senior Charge Nurse and/ or Occupational Health and Safety Advisory Service. Practical Physical Interventions Training CALM Theory in the management of challenging behaviour. This 2 day course covers 12 different topics related to aggression management within the Hospital setting. Topics include the causes of violence, the legislative framework, Organisational Policy and support issue. Staff need attend this course only once, but will be expected to attend CALM Theory refresher training every three years following this. CALM Theory CALM Theory refresher training is for staff who have already attended the 2 day CALM Theory sessions. This course summarises much of the content of the 2 day course but also includes up to date developments relevant to the learning disability care setting such as Legislative changes, best practice guidelines etc. Staff attending this course will learn how to apply Core physical Intervention techniques, high tariff techniques and descents. Emphasis is placed on merging CALM Theory with CALM Physical Interventions techniques. Staff will have the opportunity to practice all techniques until each participant is deemed to be competent. Once the CALM Instructor believes competency has been achieved, staff will go through verification. In order to remain accredited in the use of CALM Physical Intervention Techniques, staff will be required to go through verification every 12 months. If they do not attend a Re-accreditation course within 12 months, their accreditation will lapse. If the accreditation lapses over 15 months, staff will need to attend a further 3 day Initial Training course. Escape Techniques and role play Staff attending this course will learn a variety of escape techniques, and spend time practising these techniques in different scenarios. There will also be a focus on merging escape techniques with simulated scenarios involving the CALM Physical Intervention techniques. CALM Physical Interventions: includes reference to the CALM approach, key principles of Physical Interventions, Health & Safety issues and legal guidelines. Senior Charge Nurses have overall responsibility for all aspects of support delivered via their services, and this includes responsibility for implementation of CALM, monitoring its use and ensuring that staff practice regularly. It is a requirement that staff attend updates on 3 occasions per year. Senior Charge Nurses must therefore ensure that all ward based staff attend both CALM Theory and CALM Physical Intervention training. Verification in order to ensure adherence to CALM s Quality Standards and BILD s good practice guidelines, verification of participants is carried out by an additional CALM Instructor who has not been involved in the training. Each participant must demonstrate every technique in order to be assessed on their

5 performance. Any participant who requires more than 2 prompts on any one technique will fail on that technique. Failure on more than 2 techniques constitutes failure of the overall course. Any participant who fails will be required to attend another practice and verification session. They should not use any of the CALM techniques in the intervening period. A written verification report will be prepared by the verifier which will be forwarded to Senior Charge Nurses and Lead Nurses and then on to CALM Training Services. This will have individual reports on each staff member s performance at the verification. The staff member s name will then be recorded on CALM Training Services Ltd database and the database held by the CALM Training Co-ordinator. 2. Follow-up to Training a) Practice practice must be done 3 monthly. These update practice sessions are facilitated by a CALM instructor. In addition should a specific query relating to a client or interventions CALM instructors are available to discuss and facilitate ward based practice. Senior Charge Nurses must take responsibility for ensuring that staff practice regularly; staff who do not practice leave themselves open to the possibility of claims being made against them in the event of any injury while carrying out a Physical Intervention. Senior Charge Nurses should take overall responsibility for coordinating practice but individual staff should ensure they practice regularly. Senior Charge Nurses should monitor any issues in relation to use of and practice of interventions. CALM instructors are available to support with additional practice if this is required, and written descriptions of the Physical Interventions are also available. b) Restrictive Intervention Management Plans Physical Interventions management Plans must be written as soon as possible after admission. Plans must provide the detail and examples to ensure that these are person-specific. c) New staff and Bank staff: All new staff and Bank staff who do regular shifts within the Learning Disability Service are required to be trained in CALM theory, Physical Intervention techniques or Escapes techniques dependent upon the area in which they will are based. This training should take place as soon as it can be arranged; the Senior Charge Nurses are responsible for arranging this. Staff not CALM trained are not permitted to use any Physical Interventions. Bank Staff who do not attend CALM Updates will not be given shifts with the Fife LD Service. Bank Staff are responsible for ensuring that they attend update sessions. d) PDP It is the responsibility of each staff member to ensure they attend all relevant mandatory training and keep up to date records in PDPs. In the event of non-attendance, the individual must inform the CALM Co-ordinator and line manager

6 2.8 Recording and reporting the use of other restrictive practices 3. Long Term Follow-up Reaccreditation training must take place within one year. Staff are deemed competent through verification and this is valid for one year. The CALM system is registered under the British institute of Learning Disabilties as an accredited aggression management system. All staff that are trained in CALM physical Interventions must be evaluated against specific competencies. During verification, participants will be expected to demonstrate competency in each of the techniques they demonstrate. If a serious error is made during demonstration of a technique, then the staff member will be asked to repeat the move. 2 incorrect demonstrations will mean a failure of that technique, failure of 2 or more techniques constitutes failure to complete the course. Students who show repeated hesitancy or who rely on prompts from colleagues to correctly demonstrate techniques may be deemed to have failed to demonstrate competence. Participants who are unsuccessful in completing the programme will be offered additional training and support from the CALM Training Instructors, and can then re-apply for verification. Participants may be asked to complete the full 2 day programme again.