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Update from the Care Quality Commission on monitoring and oversight of restrictive practices

Julie HankinJulie Hankin

Julie opened her presentation by saying that the aims within the next 2 years are:

Encourage a culture across health and social care organisations that is committed to developing therapeutic environments where physical interventions are only used as a last resort

Provide guidance on the use of effective governance arrangements and models of restrictive intervention reduction so that lasting reductions in the use of restrictive interventions of all forms can be achieved

Help promote best practice principles across a range of health and social care settings and to ensure that restrictive interventions are used in a transparent, legal and ethical manner

Julie went on to say that the annual reports should show evidence of:

Effective leadership
Culture with models such as safewards and recovery-orientated practice
Staff are appropriately trained in preventative strategies, positive behaviour support or equivalent and restrictive interventions
Incidents of restriction/restraint monitored using agreed terminology and recorded in agreement with the MCA
Annual audits
Lessons learnt from debriefs resulting in change
Progress on the policy to reduce restrictive interventions reported to the board

What do the CQC expect now with relation to restrictive practices? Sept to April 2015

•Restrictive intervention reduction programme in place
•Appropriate governance structures in place with transparent policies around the use of restrictive interventions
•Clinical audit able to evidence care plans incorporate the key principles of positive behaviour support plans and where relevant are compliant with the Mental Capacity Act
•Clear and accurate recording of restrictive interventions with full reporting to commissioners and nationally
•Post incident reviews and debriefs happen routinely
•Evidence of the involvement of service users, carers, advocates and other relevant representatives in care planning and post-incident debrief
•Evidence that staff using restrictive interventions are appropriately trained

Julie updated delegates on the finding from the first waves of inspections under the new CQC inspection process in mental health. Of the first 10 inspections and the 9 reports that have been published 7 had issues identified with restraint and seclusion and 3 had specific complaince actions relating to this. Key issues included staff knowledge and understanding of seclusion policies (particularly bank and agency), use of seclusion where no policy exists, recording of restraint and seclusion, issues with mental health review of seclusion, environment of seclusion rooms, training and supervision and lack of board oversight. 

State of Care 2013-14 View HERE

Useful Links:

NHS Protect released a series of training videos to complement the ‘Meeting needs and reducing distress’ guidance document, as a tool to assist in challenging behaviour awareness training or as a standalone learning resource for healthcare staff. View the guidance document HERE

New advice for staff on the use of restrictive interventions for patients with difficult behaviour
Positive and Proactive Care: reducing the need for restrictive interventions View here
Positive and Proactive Care: reducing the need for restrictive interventions View here

Events of interest:

Masterclass: The Legal use of Control and Restraint
Tuesday 4 November 2014 London

Out of Hours Care in Hospital
Tuesday 2 December 2014 London

Leading your Organisation to Zero-Harm
Tuesday 9 December 2014 Manchester

Monitoring & Improving Patient Safety
Thursday 11 December 2014 London

Masterclass: The Legal use of Control and Restraint
Wednesday 14 January 2015 London

Patient Safety, Incident Reporting, Investigation & Learning
Monday 2 February 2015 London


Download: Julie Hankin

23 October 2014


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