www.nhsprotect.nhs.uk

Andrew MastermanPolicy Lead Violence Strategy Date 26 06 14

Collaborative approach

Timeline

Zero Toleranc

eNHS SMS NHS

Protect

Winterbourne /

Mid Staffs

MINDMeeting Needs

DH guidance

Minimising the use of physical restraint

RCN - Positive and Proactive

Care

SfHealth/Care - Positive and

Proactive Workforce NHS Protect -

Meeting Needs and Reducing

Distress

MH Crisis Care Concordat

MoJ - Death in Custody principles /

NHS Care in Custody

NICE - Guidelines • Violence & Aggression • LD Challenging Behaviour

RCN Forum

NHS England -NRLS and

Patient Safety Incidents

RCPsych

CQC

Research

Health Education England

National picture

DH Positive & Safe Programme

•Vulnerable patients

•Other patients

•Staff

•Relatives and carers

•Organisational reputation

Why is this guidance important?

Our approach

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

TrainingLevel Core Role specific Targeted

(risk based)

Module Challenging behaviour awareness

CRT Assessment and planning Assault reduction

Physical intervention

Content • Awareness• Recognise• Prevent• Manage risks• Responsibilitie

s• Support

• 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

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