A simple approach Designing tools - RCPsych
1
Firebreak Essex Fire and Rescue conducted a week long Firebreak course at our unit. 8 patients from various wards participated in the course. The Firebreak programme aims to promote a culture of safety, team work and citizenship by teaching a range of vital life skills whilst undertaking the various disciplines of the Fire Service. It’s fair to say all the patients who participated in this course have benefited from it. Here are some pictures from the course and the final parade! Patient Story – Running a half marathon We are pleased to share an inspirational story of a patient setting himself a challenge of running a half marathon (13.1 miles) in October for charity (MIND); and he would like to share his story so far… “Where I was working somebody else had run the marathon for charity, and as I have always been interested in charity work, in the past I have done a sponsored run and bake sales for children in need, so I decided I wanted to run a marathon. It has been a few months since I have been to the gym, and even then I only trained with weights, so I am starting from scratch. I have met with the activity coordinators who have helped me with training schedules and nutrient advice. Now I have one cheat day on a Monday, but for the rest of the week I try to eat chicken and fish. For breakfast I have porridge with a chopped up banana and walnuts. This keeps me full until lunch. For training I try to go to every session at the gym I can, I start with CV, completing 20 minute interval training on the treadmill and then I move on to weights – meaning I burn calories after I leave the gym. I am currently trying to organise a sale in the sports hall, and have collected bags of clothes and DVDs, and I am also organising a bake sale to raise more money for the charity. If any patients want to contribute then that would be great.” Essex Partnership University NHS Foundation T rust Reducing Restrictive Practice A Story of Change Designing tools A simple approach Data telling a story Sharing successes C.P.A – (Care Program Approach) Every patient will have C.P.A’s they are basically large ward rounds where you discuss your care and progress. Ward Round – Every Fortnight you have a meeting with the MDT where you discuss how you are doing and bring up any requests you have. M.D.T – (Multi-Disciplinary Team) is made up of a psychologist, social worker, doctor and Occupational Therapist. 16.9 Form – Before you have a Ward Round you will be given a form where you write any requests you have so the MDT can discuss it. Key Nurse – You will be allocated a key nurse, this will be a qualified nurse who will be in charge of your care on the ward. R.C (Responsible Clinician) – Is the primary doctor in charge of your care Support Worker – Support workers are staff that can support your care on the ward. O.T (Occupational Therapists) – O.T’s run groups, all patients can attend these groups once agreed by the MDT. Groups include, Maths, English, I.T, Crop group, cooking groups and many others, speak to your ward O.T to find out more. Patients have told us how “daunting” it can be when you first arrive in hospital. They described feeling “totally lost” and said “people throw all these words at you and you don’t know what they mean”. Not understanding some of the language used inspired one patient to create what he referred to as a ‘Mental Health Translator’ to make coming onto a ward less overwhelming and confusing. The Successes Validating Staff Experience Making sense of Data Dispelling the myth of a chaotic ward Highlighting positive staff intervention Changing Perceptions Next Steps Simplified data for patients Building on verbal de-escalation data Key outcomes/priorities; Engaging patients and staff Increased understanding ‘Positive and Pro-active care’ and de-escalation Data telling a story A culture of openness Continuous conversation is central to evolving the agenda Meaning to staff Physical restraint Unnecessary boundaries Restricting room access Blanket rules Asking 5 simple questions 1.What does Restrictive Practice mean to you? 2.How have you experienced Restrictive Practice since you’ve been on the ward? 3.If you had any concerns, how would you raise them? 4.If you’ve ever raised any concerns, did you feel listened to or have steps been taken to address the issues you raised? 5.Would you like to be involved in discussing how we could improve care relating to restrictive practices? Meaning to patients Things we can’t do at certain times Not being able to do things you want to do Rules for our protection Compromising Security Training We are pleased to say that the two of our patients that have been involved in the delivery of security training for clinical staff, have received positive feedback. The patients give a personal account of what it is like to be detained and the way they feel when they were unwell. They share their recovery journey in cluding activities of daily living, relationship with staff amongst many topics. Members of staff have told us how helpful it is to hear the patient’s per spective from a relational security training point of view. Patient Story ‘Dear all, I am getting on okay. Learning the price of milk, learning the price of bin bags. Novel-ties that I’m sure will soon wear off. I like the flat and its furnishings very much. I have a double bed now and a floriferous du-vet cover which they laid on for me and is much to my taste. I am now the proud own-er of my own Minky ironing board. No more hovering around the laundry room for me … … The cat is meowing for attention. A tortoise shell with a tiny head and a saggy belly it skitters from flat to flat never knowing where its next meal is coming from. I am scared of locking it in and scared of locking it out … … I was here for a week when [another pa-tient I know] showed up. What a joy! [This patient] carries all the conversation with [them] so I don’t have to make any. We are going to the beach on Thursday for a cold walk and a hot coffee. Going to enjoy a solidity fag on my front stoop someone always pops up from the flat opposite… …Missing you all and your various Idiosyncrasies.’ Mobile Phones on Wards We are pleased with the progress on having mobile phones on the wards. Currently we have mobile phones on three wards. In March and April, a further three will implement mobile phones. Having a mobile phone will be individually care planned and risk assessed, with the MDT. The phone will be the property of the hospital; however, if you are granted access to a phone, you will be able to buy your own sim. Phones will conform to security standards of the hospital and as such cannot be a smart phone. Vapes Eburn’s are the vapes now available. The Eburn’s stocked come in two varieties; tobacco and menthol. Both varieties can be purchased in the shop and the canteen. Well –Led Award CEO Award Patient Compliment “Thank you for your kind care and for making conversation with me when I wasn’t very amenable. I remember you saying that if I were to drink it would lead me down a very dark tunnel and it helps keep me sober. Thank you for taking me seriously, for treating me with respect and for always saying the right thing at the right time. With Gratitude” A Big Thank You from Recovery College We would like to thank all the patients who have presented their suggestions for potential Recovery College courses. A further thank you to all patient tutors, who have shared their knowledge and experience with their peers. Last but certainly not least, thank you to the patients who sit on the Recovery College steering group. It is this fantastic level of involvement and support from patients that makes Recovery College so special - keep it up! “We don’t always turn around and thank staff. Would like to do that now” 78.9% verbal de-escalations in 2017/18 89% decrease in restraints on one ward 78% seclusion reduction on one ward Strong links with Recovery College Well done and congratulations to all the participants and a big thank you to all the staff that participated and supported this course. Following on the success of this program, we aim to run another course in autumn 2018. Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar T Total Restraints 2 12 3 5 3 0 0 2 3 2 0 4 Total Number of Patients restrained 1 5 3 2 3 0 0 1 2 1 0 2 Number of Patients restrained multiple times (highlighted in green) 1 5 0 2 0 0 0 1 2 1 0 2 Patient 1 2 1 0 0 0 0 0 0 0 0 0 1 Patient 2 0 6 0 0 1 0 0 0 0 0 0 0 Patient 3 0 2 1 0 0 0 0 2 0 0 0 0 Patient 4 0 1 1 2 0 0 0 0 1 0 0 0 Patient 5 0 2 0 3 1 0 0 0 0 0 0 0 Patient 6 0 0 1 0 0 0 0 0 2 0 0 0 Patient 7 0 0 0 0 1 0 0 0 0 2 0 0 Patient 8 0 0 0 0 0 0 0 0 0 0 0 3 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Anti-Social Behaviour 1 2 1 2 0 0 0 1 0 0 0 1 Assault - Physical 1 3 1 2 3 0 0 0 0 1 0 2 Property Damage 0 0 0 1 0 0 0 0 0 1 0 0 Assault - Non Physical (Verbal) 0 2 0 0 0 0 0 0 1 0 0 0 Self Harm 0 5 1 0 0 0 0 1 2 0 0 0 Admission 0 0 0 0 0 0 0 0 0 0 0 1 Totals: 2 12 3 5 3 0 0 2 3 2 0 4 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Incidents were de-escalation was successful (no restraint undertaken) 7 15 7 8 7 5 0 5 8 8 2 3 Incidents were de-escalation failed and restraint undertaken 2 12 3 5 3 0 0 2 3 2 0 4 Totals 9 27 10 13 10 5 0 7 11 10 2 7 Rate of incidents involving successful de-escalatio 78% 56% 70% 62% 70% 100% N/A 71% 73% 80% 100% 43% Patients Categories of Incident leading to/cause of Restraint De-Escalation WARD NAME Restraint & De-Escalation Data 2016/17 Restraint Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total Total Restraints (de-escalation unsuccessful) 1 1 1 0 0 0 0 3 5 1 3 6 21 Successful Verbal De-Escalation 2 0 4 9 1 3 0 11 13 7 10 14 74 Totals incidents (Restraints + De- escalations) 3 1 5 9 1 3 0 14 18 8 13 20 95 Rate of incidents involving successful de- escalation 67% 0% 80% 100% 100% 100% 0% 79% 72% 88% 77% 70% 90% Total Restraints 1 1 1 0 0 0 0 3 5 1 3 6 15 Total Prone Restraints 0 0 0 0 0 0 0 2 1 0 1 2 6 Rate of incidents involving Prone restraint 0% 0% 0% 0% 0% 0% 0% 67% 20% 0% 33% 33% 40% Total Number of Patients restrained 1 1 1 0 0 0 0 2 4 1 3 2 15 Number of Patients restrained multiple times 0 0 0 0 0 0 0 1 1 0 0 2 4 Patient 1 1 1 Patient 2 1 1 Patient 3 1 1 Patient 4 1 1 3 5 Patient 5 2 1 1 1 3 8 Patient 6 1 1 Patient 7 2 2 Patient 8 1 1 Patient 9 1 1 Anti-Social Behaviour 0 0 0 0 0 0 0 2 1 1 2 3 9 Assault - Non Physical (Verbal) 1 0 0 0 0 0 0 0 1 0 0 2 4 Assault - Physical 0 1 1 0 0 0 0 1 3 0 1 1 8 Rapid Tranquillisaiton used 0 1 0 0 0 0 0 1 2 0 1 3 8 Physical observations were undertaken after the incident 0 0 0 0 0 0 0 2 1 0 0 2 5 Patients in Seclusion 0 2 1 0 0 0 1 3 3 1 0 1 12 Patients in LTS 0 0 0 0 2 0 0 2 1 0 3 7 15 Seclusion and Long Term Segregation (LTS) Ward Name Restraint & De-Escalation Data 2017/18 Restraint Individual Patients* Categories of Incident leading to / cause of Restraint Prone Restraints Patient Data Medication Administration Sir Peter Carr Finalist What it is… It is about reducing risk and maintaining safety using the least restrictive option available It is about promoting freedom autonomy and choice even in a restrictive environment It is about showing empathy, respect, being helpful and taking responsibility for our actions What it is not… It is not to punish or humiliate It is not about placing unnecessary restrictions on service users It is not about compromising safety and security It is not about managing staffing levels It is not about getting rid of all rules and regulations What are Blanket Rules? Rules or policies that restrict a patient’s liberty and other rights, which are routinely applied to all patients, or to classes of patients, or within a service, without individual risk assessments to justify their application Examples may include: Not having access to fresh air Not having access to the internet No access to mobile phones Not having access to incoming or outgoing mail Not allowing visitors Not having access to money Not being able to take part/forced to take part in activities The doors are locked Having specified bed times Limited access to food Limited bedroom access Where there is a blanket restriction in place, there should be evidence that a discussion has taken place with the service user/s and documented accordingly. There are some blanket restrictions due to external factors such as legislation which limits what we can / can’t do within the service Seclusion and LTS Pathway Unplanned event Immediate necessity Severely disturbed behaviour likely to cause harm to others Supervised confinement and isolation Designated room Continuous observation, recorded every 15 minutes Seclusion Scenario 2 A person presents an almost continuous risk of serious harm to others A person presents with severely disturbed behaviour likely to cause harm to others (and or self) Long-Term Segregation Planned intervention Continuous risk of serious harm to others Person would benefit from a period of intensive care and support that minimises their contact with other users of the service Discrete area Continuous observation, recorded hourly Away from other users of service Prevented from leaving the area Only be used in hospitals Can be in any area A person is prevented from mixing freely with other people who use the service Differences Similarities Scenario 1 A decision to either seclude or long term segregate a patient will be the decision of the MDT based on the patients mental health presentation and risk.
Transcript of A simple approach Designing tools - RCPsych
Firebreak
Essex Fire and Rescue conducted a week long Firebreak course at our unit. 8 patients from various wards participated in the course. The Firebreak programme aims to promote a culture of safety, team work and citizenship by teaching a range of vital life skills whilst undertaking the various disciplines of the Fire Service. It’s fair to say all the patients who participated in this course have benefited from it. Here are some pictures from the course and the final parade!
Patient Story – Running a half marathon
We are pleased to share an inspirational story of a patient setting himself a challenge of running a half marathon (13.1 miles) in October for charity (MIND); and he would like to share his story so far…
“Where I was working somebody else had run the marathon for charity, and as I have always been interested in charity work, in the past I have done a sponsored run and bake sales for children in need, so I decided I wanted to run a marathon.
It has been a few months since I have been to the gym, and even then I only trained with weights, so I am starting from scratch. I have met with the activity coordinators who have helped me with training schedules and nutrient advice. Now I have one cheat day on a Monday, but for the rest of the week I try to eat chicken and fish. For breakfast I have porridge with a chopped up banana and walnuts. This keeps me full until lunch.
For training I try to go to every session at the gym I can, I start with CV, completing 20 minute interval training on the treadmill and then I move on to weights – meaning I burn calories after I leave the gym.
I am currently trying to organise a sale in the sports hall, and have collected bags of clothes and DVDs, and I am also organising a bake sale to raise more money for the charity. If any patients want to contribute then that would be great.”
Essex Partnership UniversityNHS Foundation Trust
Reducing Restrictive PracticeA Story of Change
Designing toolsA simple approach
Data telling a story
Sharing successes
C.P.A – (Care Program Approach) Every patient will have C.P.A’s they are basically large ward rounds where you discuss your care and progress.
Ward Round – Every Fortnight you have a meeting with the MDT where you discuss how you are doing and bring up any requests you have.
M.D.T – (Multi-Disciplinary Team) is made up of a psychologist, social worker, doctor and Occupational Therapist.
16.9 Form – Before you have a Ward Round you will be given a form where you write any requests you have so the MDT can discuss it.
Key Nurse – You will be allocated a key nurse, this will be a qualified nurse who will be in charge of your care on the ward.
R.C (Responsible Clinician) – Is the primary doctor in charge of your care
Support Worker – Support workers are staff that can support your care on the ward.
O.T (Occupational Therapists) – O.T’s run groups, all patients can attend these groups once agreed by the MDT. Groups include, Maths, English, I.T, Crop group, cooking groups and many others, speak to your ward O.T to find out more.
A.C (Activities Coordinators) – Like O.Ts A.Cs also run groups, they also run the gym and sports activities.
Advocate – Advocates are independent of the hospital and are there to deal with any complaints or issues you have, you can ask them to attend your ward rounds for support if you wish.
M.O.J (Ministry of Justice) - If you are a sentenced prisoner or on a section 37.41 any decisions about leave or your progression must be agreed by the M.O.J.
P.R.N - If a patient is unwell and needs something to help calm their distress P.R.N can be issued. PRN is a Latin term that stands for “pro re nata” which means “as the thing is needed.”
I.V.M – Sometimes it may be necessary for medication to be given through an injection if your behaviour poses a risk to you, another patient or a member of staff.
Seclusion/ I.C.U – Patients whose behaviour poses a risk to their selves, another patient or a member of staff may be placed into Seclusion or into the I.C.U (Intensive Care unit) for a short time until the team feel it is safe for you to come out.
Section 17 – Whenever you go on perimeter leave or leave outside of the grounds you must a have a section 17 signed by a doctor. This includes conditions of your leave.
Green Form – When you wish to take money out of welfare over the £40 you are allowed, a green form must be completed and signed by a doctor.
Patients have told us how “daunting” it can be when you first arrive in hospital.They described feeling “totally lost” and said “people throw all these words at you and you don’t know what they mean”. Not understanding some of the language used inspired one patient to create what he referred to as a ‘Mental Health Translator’ to make coming onto a ward less overwhelming and confusing.
The Successes
Validating Staff Experience
Making sense of Data
Dispelling the myth of a chaotic ward
Highlighting positive staff intervention
Changing Perceptions
Next Steps
Simplified data for patients
Building on verbal de-escalation data
Key outcomes/priorities;
Engaging patients and staff
Increased understanding
‘Positive and Pro-active care’ and de-escalation
Data telling a story
A culture of openness
Continuous conversation is
central to evolving the agenda
Meaning to staff
Physical restraint
Unnecessary boundaries
Restricting room access
Blanket rules
Asking 5 simple questions
1. What does Restrictive Practice mean to you?
2. How have you experienced Restrictive Practice since you’ve been on the ward?
3. If you had any concerns, how would you raise them?
4. If you’ve ever raised any concerns, did you feel listened to or have steps been taken to address the issues you raised?
5. Would you like to be involved in discussing how we could improve care relating to restrictive practices?
Meaning to patients
Things we can’t do at certain times
Not being able to do things you want to do
Rules for our protection
Compromising
Security Training
We are pleased to say that the two of our patients that have been involved in the delivery of security training for clinical staff, have received positive feedback.
The patients give a personal account of what it is like to be detained and the way they feel when they were unwell. They share their recovery journey in cluding activities of daily living, relationship with staff amongst many topics. Members of staff have told us how helpful it is to hear the patient’s per spective from a relational security training point of view.
Patient Story
‘Dear all,
I am getting on okay. Learning the price of milk, learning the price of bin bags. Novel-ties that I’m sure will soon wear off. I like the flat and its furnishings very much. I have a double bed now and a floriferous du-vet cover which they laid on for me and is much to my taste. I am now the proud own-er of my own Minky ironing board. No more hovering around the laundry room for me …
… The cat is meowing for attention. A tortoise shell with a tiny head and a saggy belly it skitters from flat to flat never knowing where its next meal is coming from. I am scared of locking it in and scared of locking it out …
… I was here for a week when [another pa-tient I know] showed up. What a joy! [This patient] carries all the conversation with [them] so I don’t have to make any. We are going to the beach on Thursday for a cold walk and a hot coffee. Going to enjoy a solidity fag on my front stoop someone always pops up from the flat opposite…
…Missing you all and your various Idiosyncrasies.’
Mobile Phones on Wards
We are pleased with the progress on having mobile phones on the wards. Currently we have mobile phones on three wards. In March and April, a further three will implement mobile phones.
Having a mobile phone will be individually care planned and risk assessed, with the MDT.
The phone will be the property of the hospital; however, if you are granted access to a phone, you will be able to buy your own sim. Phones will conform to security standards of the hospital and as such cannot be a smart phone.
Vapes
Eburn’s are the vapes now available. The Eburn’s stocked come in two varieties; tobacco and menthol. Both varieties can be purchased in the shop and the canteen.
Well –Led AwardCEO Award
Patient Compliment
“Thank you for your kind care and for making conversation with me when I wasn’t very amenable. I remember you saying that if I were to drink it would lead me down a very dark tunnel and it helps keep me sober. Thank you for taking me seriously, for treating me with respect and for always saying the right thing at the right time. With Gratitude”
A Big Thank You from Recovery College
We would like to thank all the patients who have presented their suggestions for potential Recovery College courses.
A further thank you to all patient tutors, who have shared their knowledge and experience with their peers.
Last but certainly not least, thank you to the patients who sit on the Recovery College steering group.
It is this fantastic level of involvement and support from patients that makes Recovery College so special - keep it up!
“We don’t always turn around and thank staff. Would like to do that now”
78.9% verbal de-escalations in 2017/18
89% decrease in restraints on one ward
78% seclusion reduction on one ward
Strong links with Recovery College
Well done and congratulations to all the participants and a big thank you to all the staff that participated and supported this course.
Following on the success of this program, we aim to run another course in autumn 2018.
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar TotalTotalRestraints 2 12 3 5 3 0 0 2 3 2 0 4 36TotalNumberofPatientsrestrained 1 5 3 2 3 0 0 1 2 1 0 2 20NumberofPatientsrestrainedmultipletimes(highlightedingreen) 1 5 0 2 0 0 0 1 2 1 0 2 14
Patient1 2 1 0 0 0 0 0 0 0 0 0 1 4Patient2 0 6 0 0 1 0 0 0 0 0 0 0 7Patient3 0 2 1 0 0 0 0 2 0 0 0 0 5Patient4 0 1 1 2 0 0 0 0 1 0 0 0 5Patient5 0 2 0 3 1 0 0 0 0 0 0 0 6Patient6 0 0 1 0 0 0 0 0 2 0 0 0 3Patient7 0 0 0 0 1 0 0 0 0 2 0 0 3Patient8 0 0 0 0 0 0 0 0 0 0 0 3 3
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarAnti-SocialBehaviour 1 2 1 2 0 0 0 1 0 0 0 1 8Assault-Physical 1 3 1 2 3 0 0 0 0 1 0 2 13PropertyDamage 0 0 0 1 0 0 0 0 0 1 0 0 2Assault-NonPhysical(Verbal) 0 2 0 0 0 0 0 0 1 0 0 0 3SelfHarm 0 5 1 0 0 0 0 1 2 0 0 0 9Admission 0 0 0 0 0 0 0 0 0 0 0 1 1Totals: 2 12 3 5 3 0 0 2 3 2 0 4 36
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarIncidentswerede-escalationwassuccessful(norestraintundertaken) 7 15 7 8 7 5 0 5 8 8 2 3 75Incidentswerede-escalationfailedandrestraintundertaken 2 12 3 5 3 0 0 2 3 2 0 4 36Totals 9 27 10 13 10 5 0 7 11 10 2 7 111Rateofincidentsinvolvingsuccessfulde-escalation 78% 56% 70% 62% 70% 100% N/A 71% 73% 80% 100% 43% 68%
FormatinuseMarch2017-April2018
Patients
CategoriesofIncidentleadingto/causeofRestraint
De-Escalation
WARDNAMERestraint&De-EscalationData2016/17Restraint
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total
TotalRestraints(de-escalationunsuccessful) 1 1 1 0 0 0 0 3 5 1 3 6 21
SuccessfulVerbalDe-Escalation 2 0 4 9 1 3 0 11 13 7 10 14 74Totalsincidents(Restraints+De-escalations) 3 1 5 9 1 3 0 14 18 8 13 20 95
Rateofincidentsinvolvingsuccessfulde-escalation 67% 0% 80% 100% 100% 100% 0% 79% 72% 88% 77% 70% 90%
TotalRestraints 1 1 1 0 0 0 0 3 5 1 3 6 15TotalProneRestraints 0 0 0 0 0 0 0 2 1 0 1 2 6RateofincidentsinvolvingPronerestraint 0% 0% 0% 0% 0% 0% 0% 67% 20% 0% 33% 33% 40%
TotalNumberofPatientsrestrained 1 1 1 0 0 0 0 2 4 1 3 2 15NumberofPatientsrestrainedmultipletimes 0 0 0 0 0 0 0 1 1 0 0 2 4
Patient1 1 1Patient2 1 1Patient3 1 1Patient4 1 1 3 5Patient5 2 1 1 1 3 8Patient6 1 1Patient7 2 2Patient8 1 1Patient9 1 1
Anti-SocialBehaviour 0 0 0 0 0 0 0 2 1 1 2 3 9Assault-NonPhysical(Verbal) 1 0 0 0 0 0 0 0 1 0 0 2 4Assault-Physical 0 1 1 0 0 0 0 1 3 0 1 1 8
RapidTranquillisaitonused 0 1 0 0 0 0 0 1 2 0 1 3 8Physicalobservationswereundertakenaftertheincident 0 0 0 0 0 0 0 2 1 0 0 2 5
PatientsinSeclusion 0 2 1 0 0 0 1 3 3 1 0 1 12PatientsinLTS 0 0 0 0 2 0 0 2 1 0 3 7 15
SeclusionandLongTermSegregation(LTS)
WardNameRestraint&De-EscalationData2017/18
Restraint
IndividualPatients*
CategoriesofIncidentleadingto/causeofRestraint
ProneRestraints
PatientData
MedicationAdministration
Sir Peter Carr Finalist
What it is…
It is about reducing risk and maintaining safety using the least restrictive option available
It is about promoting freedom autonomy and choice even in a restrictive environment
It is about showing empathy, respect, being helpful and taking responsibility for our actions
What it is not…
It is not to punish or humiliate
It is not about placing unnecessary restrictions on service users
It is not about compromising safety and security
It is not about managing staffing levels
It is not about getting rid of all rules and regulations
What are Blanket Rules? Rules or policies that restrict a patient’s liberty and other rights, which are routinely applied to all patients, or to classes of
patients, or within a service, without individual risk assessments to justify their application
Examples may include:
Not having access to fresh air Not having access to the internet No access to mobile phones Not having access to incoming or
outgoing mail Not allowing visitors Not having access to money Not being able to take part/forced
to take part in activities The doors are locked Having specified bed times Limited access to food Limited bedroom access
Where there is a blanket restriction in place, there should be evidence that a discussion has taken place with the service user/s and
documented accordingly.
There are some blanket restrictions due to external factors such as legislation which limits what we can / can’t do within the service
Seclusion and LTS Pathway
Seclusion and LTS pathway
Unplanned event Immediate necessity Severely disturbed behaviour likely
to cause harm to others Supervised confinement and
isolation Designated room Continuous observation, recorded
every 15 minutes
Seclusion
Scenario 2
A person presents an almost continuous
risk of serious harm to others
A person presents with severely disturbed behaviour likely to cause harm
to others (and or self)
Long-Term Segregation
Planned intervention Continuous risk of serious harm to
others Person would benefit from a period
of intensive care and support that minimises their contact with other users of the service
Discrete area Continuous observation, recorded
hourly
Away from other users of service Prevented from leaving the area
Only be used in hospitals Can be in any area
A person is prevented from mixing freely with other people who use the service
Differences
Similarities
Scenario 1
A decision to either seclude or long term segregate a patient will be the decision of the MDT based on the patients mental health presentation and risk.
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