REDUCING RESTRICTIVE practices
REDUCING RESTRICTIVE practices Timeline of events 2015 we began to develop a strategy using the PBS framework as a basis. An audit of the homes was completed using a checklist for service providers (PBS academy). This allowed us to formulate an action plan. 2016 Started looking at reducing restrictive practice. Audit developed using criteria from the Promoting less Restrictive Practice by the Local Government Association. It was trialled in November 2017 and implemented in all the homes and schools 9th January 2018 joined the Restraint Reduction Network and took the pledge. Senior leadership team pledge commitment and support. Attended Restraint Reduction Network Conference in March 2018. The audit was further developed and individualised in April 2018. Due to the growth of the company an audit schedule has been developed to maintain high standards.
REDUCING RESTRICTIVE practises Audit Schedule
REDUCING RESTRICTIVE practises Any restriction imposed that limits an individual’s freedom that prevents them from having a natural quality of life This may be imposed by means including but not limited to Physical restraint Medication Seclusion Locking rooms to prevent entry or exit. Removing items Restrictions on visits Use of Visual panels in bedroom doors
REDUCING RESTRICTIVE practises
REDUCING RESTRICTIVE practises Commenced STOMP audit June – July 2017 Joined the STOMP campaign and took the pledge in January 2018. Completed a second audit and wrote to Psychiatrists requesting further reduction plans January to February 2018. Consultants Psychiatrists now attend MDT.
REDUCING RESTRICTIVE practises
REDUCING RESTRICTIVE practises Shared STOMP audit outcome with parents at Summergil; very positive responses: “I wish that I had heard of this sooner, I have previously asked for therapeutic input before medicating him and really didn’t want to do this”. “I am amazed at this thinking, x was first medicated in a previous placement, something which I didn’t want to happen, but felt pressured into this happening so that his placement would continue. I now feel hopeful that he does not need to spend his whole life on medication”.
REDUCING RESTRICTIVE Barriers practises Staff fear and anxiety about the perceived risks and change. Well received by most, a few who were quite resistant to change and challenge. Perceived as creating “more work” by managers. Staff attending medication reviews – providing subjective, non data based opinions which influence the prescriber. Parents views and beliefs around restrictions and medication. Challenge to blanket policies and practices.
Overcoming the Barriers REDUCING RESTRICTIVE practises Overcoming the Barriers Continued discussions with prescribing GPs and Psychiatrists Individual Restrictive Practice Audits completed and discuss with staff and families Insist that Psychiatrists attend MDT Spreading the word in networking days, parent forums, and reviews Sharing outcomes of audits with the Board of Directors, parents and staff. Positive monitoring and role modelling to increase confidence.
REDUCING RESTRICTIVE practises
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