Perspectives on the national objectives to end prone restraints Dr Arokia Antonysamy Director - National MHILP Consultant Psychiatrist Oxleas NHS FT @Samy_nhs
Changing landscape Global recession Clinical commissioning groups NHS England and local area teams Competitive market Francis report Ageing population Rising mental health problems
National drivers Independent inquiry into RB s death 1998 Winterbourne view report 2012 Independent advisory panel on deaths in custody report 2013 Independent commission on mental health and policing 2013 NICE 2015 short term management of violence and aggression in wards
Why NICE guidelines? Reduce variations Evidence based Improve patient safety Reduce distress for staff and patients
NICE Avoid prone restraints De-escalation Behavioural strategies Remove triggers Consider alternatives Offer debrief
Patient experience it was horrific..i had some bad experiences of being restrained face down with my face pushed into a pillow. I cant begin to describe how scary it was, not being able to signal, communicate, breathe or speak. Anything you do to try to communicate, they put more pressure on you. The more you try to signal, the worse it is service user 2013, Mind report
Patient perceptions Little staff attention Upset, ignored prior to incident Ashamed and isolated after, fear Traumatic flashbacks of previous restraint Bonner et al, 2002 Disempowering, humiliating & distressing Mind report 2013
Clinical perspective Practical difficulties Crisis has no time Immediate resolution Panic and anxiety More space Time out Allows time for reflection and change
Contents Changing culture and practices Our experience How we reduced restraints in PICU by more than 50%
Value driven culture Fairness Respect Hope and optimism Accountability Excellence Most of us thrive by making constant progress and feeling a sense of purpose Dan Ariely
No: of incidents What difference did we make? Violence and Aggression 2000 1800 1600 1400 1200 1000 800 600 400 200 0 PICU Trust 2011 482 1854 2012 126 928
. 450 400 350 300 250 200 2011 2012 150 100 50 0 Average LOS Seclusions Staff sickness
How did we make it? Radical thinking Patient and carer involvement Staff empowerment Partnership with 3 rd sector and local council Positive risk taking Supporting people to better manage their own care
Recovery from patient perspective Sense of hope, optimism, identity Parity of esteem Focus on strengths Patient empowerment Self management Time limited MaZon recovery tool The Physician 2014
Gardening Group
Blackpool Zoo
The Driving Range
I arrived at the Ward A from the Ward B and I am surprised at how excellent the forward looking and very helpful and friendly staff are. I hope the excellent Ward A can continue to push forward the boundaries of mental health I like the Ward A as it is quieter than other wards. I am glad I stayed on Ward A as it has definitely helped me to stay drug free. I feel positive and enjoyed it here. There is a good team of nursing staff and I have a good relationship with them. I have assisted staff to help other patients. I feel this is the healthiest I have ever been as I go to the gym. I go and use the computers in OT. I spend time in my room and the lounge area reading and listening to the radio All staff and doctors have been amazing in the treatment of my husband. I feel if he hadn t have been sent to Ward A it could have taken a lot longer for him to progress as good as he has. Myself and the boys have nothing but praise Overwhelmed with the staff and the doctors, the good work everybody does, the way I have been cared for the hygiene, never been left unclean, so happy I have been here, sad to be leaving, but God has been good Life, Courage, Hope, I will take it with me til my dying day. It s like winning the lottery, it s like the Hilton, thank you all so much! We re very grateful to the staff on Ward A for the care and support being given to Dad. We know how extremely challenging his behaviour can be and appreciate that he is being treated with dignity and compassion. Thank you for keeping us informed. It is hard living so far away and appreciate the phone contact
Hope and Optimism
Share lessons Disseminated our project findings across the Trust Best practice rolled out in emerging projects Published in the BMJ Quality Improvement report (13 th May 2013)
Long term impact Policy changes NAPICU membership Competitive recruitment Share lessons with Rethink work stream Wider contribution at the strategic clinical networks and clinical transformation boards
Reflections Involve other teams in early phase Establish role with new commissioners Involve other providers - eg catering services promoting healthy lifestyles, sponsoring vegetable gardens Share learning with redesign group Multiply champions
Thank you