1. Andrew Masterman
Policy Lead Violence Strategy
Date

2. Collaborative approach

3. 2000 2004 2011 2012 2013 2014 Timeline Zero Tolerance NHS SMS
NHS Protect
Winter
bourne / Mid Staffs
MIND
Meeting Needs
DH guidance

4. 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

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

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

7. 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

8. 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

9. 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

10. 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

11. 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

13. 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

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