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ELIMINATING SUPINE RESTRAINT: Improving patient and staff safety using Safety Pods
Sarah Trute – Qi Lead for LD & Rehab, Surrey & Borders Partnership Trust
Welcome

2. Restrained too long in an unsafe position…
Situation
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Restrained too long in an unsafe position…
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if we don’t move away from poor practices people will continue to be traumatised, get injured, or die
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3. Background
Welcome
Plethora of reducing restrictive practice guidelines available: Learning Disability Mortality Review; NICE guidelines NG10 violence & aggression; short-term management in mental health, health and community settings: when using manual restraint, avoid taking the person to the floor but if it does become nec. use supine (face up position) or if prone (face down) shortest time possible/promoting choice and dignity.
Data: National picture / Learning Disability Mortality Review (LeDeR) statistics.
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4. Welcome Background Qi Project Use of Safety Pod: Restraint reduction
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Qi Project Use of Safety Pod: Restraint reduction
The Deacon Unit is a 10-bed inpatient facility for people with a LD/MH who require crisis mental health support. (Epsom)

5. Safety Pod impact
The Safety Pod was introduced as a QI Project June 2018.
We tested the effect on patient and staff safety, as well as impact on ground restraints.
There have been no supine restraints since the introduction of the Safety Pod.
 Type of restraint
Pre Safety Pod 01/03/ /06/18
Post Safety Pod 15/06/ /09/18
Supine 7
Sitting 9 2
Standing   23 5
Safety Pod 26

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AIM PRIMARY DRIVERS SECONDARY DRIVERS
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7. PDSA Testing Ramps for….
DATA FEEDBACK TO FRONTLINE STAFF
Cycle 6. Next Steps: Scale & Spread …
Cycle 5:
Safety Pod Datix & Recording
Cycle 4:
Training developed & delivered
Cycle 3:
Purchase, Maintenance & Contract of Safety Pods
Cycle 2:
Care Planning & Risk Assessments
Cycle 1: Staff Experience - Confidence Questionnaire

8. Welcome Measurement OUTCOME: No. of supine restraints per month
PROCESS: % Perceived Safety & Ease of applying PI using Pods by Staff
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9. Safety Pod impact
The Safety Pod was introduced as a QI Project June 2018.
We tested the effect on patient and staff safety, as well as impact on ground restraints.
There have been no supine restraints since the introduction of the Safety Pod.
 Type of restraint
Pre Safety Pod 01/03/ /06/18
Post Safety Pod 15/06/ /09/18
Supine 7
Sitting 9 2
Standing   23 5
Safety Pod 26

10. Training Team Input Safety Pod purchased
Entire staff team and MDT received initial training
On-going remote support and advice
On-site visits for problem solving / address concerns
Regular and on-going refresher training

11. Case Example
20 yr male, displays high levels of SIB: blinded himself in one eye, multiple detachments in other eye.
Would repeatedly bang his head on the floor during supine restraints
5 staff members were involved in each supine restraint.
Staff found this challenging - lead to multiple patient and staff injuries.
Young man now chooses to sit proactively in the Safety Pod for deep pressure feedback.
Can be supported safely by 2 members of staff – sometimes requiring a third person to support with the leg guard.
On average, No. restraints have halved, compared to previous admission.

12. Staff survey – pre and post questionnaires

13. Welcome Quantitative Data Main title for slide set
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14. Welcome Qualitative Data Main title for slide set
I have never seen a new practice enhancement be taken up so quickly with as much consistency as the safety pod, it is easy to use and has made a positive impact to both patients and staff - Manager
The safety pod encourages better communication and more positive interactions when a patient is being restrained. It enables you to have good eye contact at the same level as the person rather than looking down at them – Staff Nurse
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The safety pod has increased the safety for both the patient and staff during restraints and seems much more dignified than supine restraints – Support worker
Safety pod is good, it feels comfortable and is very relaxing - Patient

15. Scale & Spread Deacon ordered 3 more pods and leg guards
Interest by 4 other MH Inpatient Wards (PICU, acute, dementia, independent living)
X20 Safety Pods order placed for trial across SABP

16. Welcome Benefits to others Enhanced safety of PI (patients & staff)
Better staff confidence
Improved patient experience (dignity, coms, sensory - effective tool for de-escalation via sensory feedback,)
Reduced staffing requirements for PI
Maintains therapeutic relationship
Reduces physical and medical risk/harm/injury
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17. Welcome Recommendations: Barriers and challenges considerations:
Training - Skilled and specific
Culture - Not seen as a ‘restraint chair’
Spread - Acute Care forum: enthusiasm to spread - but is it Qi?
Maintenance of Safety Pod - location!!
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18. Key Improvement Message
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The use of a Safety Pod eliminated the need for ground restraints
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