Andrew Masterman
Policy Lead Violence Strategy
Date 26 06 14
www.nhsprotect.nhs.uk
Collaborative approach
Timeline
Zero
Tolerance
2000
NHS SMS
2004
NHS
Protect
2011
Winter
bourne /
Mid
Staffs
2012
MIND
Meeting
Needs
2013
DH
guidance
2014
National picture
Minimising the use of physical restraint
MH Crisis Care
Concordat
DH Positive & Safe Programme
RCN - Positive and
Proactive Care
NHS Protect Meeting Needs and
Reducing Distress
SfHealth/Care Positive and
Proactive
Workforce
MoJ - Death in
Custody principles /
NHS Care in Custody
NICE - Guidelines
• Violence & Aggression
• LD Challenging
Behaviour
NHS England NRLS and Patient
Safety Incidents
RCN Forum
Research
RCPsych
CQC
Health
Education
England
Why is this guidance important?
• Vulnerable patients
• Other patients
• Staff
• Relatives and carers
• Organisational reputation
Our approach
Preventing
challenging
behaviour and
minimising
restrictive
practices…
Intervene
Manage
Prevent
Understand
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
Training
Level
Core
Module
Challenging
behaviour
awareness
Content
• Awareness
• Recognise
• Prevent
• Manage risks
• Responsibilitie
s
• Support
Audience
Role specific
Targeted
(risk based)
CRT
Assessment and planning
Assault
reduction
Physical
intervention
• Risk awareness
• Dynamic risk
assessment
• Communication
• Calming
• Responsibilities
• Reporting
• Support
• Assess & diagnose
• Care planning
• Individualised care
• Prevention
• Special observation
• Behaviour
management
• Problem solving
• Recording
• Support
• Risk
awareness
• Positioning
• Safer
practices
• Avoiding
blows
• Releases
• Guiding &
redirecting
• Policy, law,
ethics
• Appropriate
restrictive
skills
• Medical risks
• Duty of care
• Teamwork
• Leadership
• Emergency
response
Nurses, doctors, AHP
Nurses,
doctors,
AHP in high
risk areas
Response
teams, security
function
All staff with direct patient contact
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