Andrew Masterman Policy Lead Violence Strategy Date 26 06 14

Collaborative approach

2000 2004 2011 2012 2013 2014 Timeline Zero Tolerance NHS SMS NHS Protect Winter bourne / Mid Staffs MIND Meeting Needs DH guidance

National picture Minimising the use of physical restraint DH Positive & Safe Programme MH Crisis Care Concordat MoJ - Death in Custody principles / NHS Care in Custody RCN - Positive and Proactive Care SfHealth/Care - Positive and Proactive Workforce NHS Protect - Meeting Needs and Reducing Distress NICE - Guidelines Violence & Aggression LD Challenging Behaviour NHS England -NRLS and Patient Safety Incidents RCN Forum RCPsych Research CQC Health Education England

Why is this guidance important? Vulnerable patients Other patients Staff Relatives and carers Organisational reputation

Our approach Intervene Manage Prevent Understand Preventing challenging behaviour and minimising restrictive practices…

Understand What is meant by clinically related challenging behaviour Clinical condition or other factors How it presents and early signs Antecedents and triggers Common reasons - physical, cognitive, psychological/emotional, environmental/social Translate unmet needs into delivery of care

Manage risk Recognise a person’s vulnerability Implement strategies to stay safe Manage escalating situations Deal with immediate, obvious causes Consider other strategies, e.g. assistance, observations Know when to use physical interventions in emergency situations Review incident

Prevent Recognise individual's rights and dignity Positive engagement, attitudes, communication critical to prevent challenging behaviour Information gathering, observation and assessing behaviours when planning care Plan individualised care: understand what causes behaviour, what alleviates it, what can we do differently; document and share with colleagues Factors: communication, environment, activities, independence, mobility, sleep, rest and nutrition Review care plan

All staff with direct patient contact Training Level Core Role specific Targeted (risk based) Module Challenging behaviour awareness CRT Assessment and planning Assault reduction Physical intervention Content Awareness Recognise Prevent Manage risks Responsibilities Support Risk awareness Dynamic risk assessment Communication Calming Reporting Assess & diagnose Care planning Individualised care Prevention Special observation Behaviour management Problem solving Recording Positioning Safer practices Avoiding blows Releases Guiding & redirecting Policy, law, ethics Appropriate restrictive skills Medical risks Duty of care Teamwork Leadership Emergency response Audience All staff with direct patient contact Nurses, doctors, AHP Nurses, doctors, AHP in high risk areas Response teams, security function

Resources Versatile video resource Supports guidance Learning outcomes Relevant to clinical and non-clinical staff Scenarios to understand, prevent, manage behaviour Shared expertise and practical advice

www.nhsprotect.nhs.uk/reducingdistress

The future? Guidance, website and video resources Project implementation and evaluation Future engagement: participate in work streams to minimise restrictive interventions Identify opportunities for further work Training

CONTACT DETAILS: andrew.masterman@nhsprotect.gsi.gov.uk