Speaker: Kevin Gournay Emeritus Professor, Institute Psych,Kings College, Chartered Psychologist and Registered Nurse
Discusses a range of policies here and overseas regarding restraint and seclusion such as:
National Standards for MHS 2010 notable is that the MHS reduceds and where possible elimateds the use of restraint and seclusion within all MHS settings and staff are trained appropriately.
Discusses tbere are just under 12,ooo episodes of seclusion in Australia each year, happening 33 times each day.
So what is Seclusion: the confinement of the consumer at any time of day or night alone in a room where free exit is prevented
Restraint - Physical, Chemical and Emotional
Cultural Differences in mgt of violence in in patient care differs across the world
USA - restraint using restraint beds and use of security staff, Europe (aprt from UK and EIRE) mechanical restraint, restint beds, net beds and restraining jackets all sorts of ways to mechaically restrain patients.
UK- Ireland – control and restraint and breakaway techniques – not using mechanical restraints only in extreme circumstances
NICE
-Nice guidelines are likely to constitute a responsble body of medical opinion for hte purposes of litigation
- Doctors are advised to record their reasons for deviating from NICE guidelines – a deviation may not be regarded as logically defensible.
Background to NICE guidelines goes back a long way. Paper for Ministers 1997, SNMAC in patient care (1997-1999), deaths in restraints (David Bennett), Joint UK Parl Cmttee on Human Rights (Dec 2004)
-NICE was a three year programme with range of professionals and did systematic Cochrane reviews, public consultations, focus groups, expert groups, economic appraisals, guideline groups and more…It also also reviewed every five years.
NICE AREAS:
- prediction and assessment
- environment
- de escalation
- physical interventions
- rapid tranquillisation
- gender, disability, race and culture
- service user perspectives
Each of the above elements are discussed in detail please note the website will be supplied at the end of the talk where you can get further information.
Predicting Violence
Past behaviour predicts future behaviour but difficult to predict.
Prevention: de escalation, observation, four levels, observation procedure. We need a lot of training to do justice to the topic.
He discusses how service users say what is going to work for them: yes give me this particular medication does work, etc but a varied range of responses.
What has happened since 2005- positive changes?
-evidence of compliance with NICE
-increasing emphasis on human rights
-apparent reduction in use of seclusion
-increasing emphasis on dangers of restraints
-increasing efforts to disseminate training including emphasis on spectrum from deescaltion to C and
- reduction in deaths in restraints
Negative Changes in UK since 2005?
-perceived increase in levels of violence
-more police involvement in patient violence – linked with street drug use
-prone position debate (prone position restraint banned in Wales)
-still no clear consensus about training, little evidence to support effectiveness of training.
-results of research into training in physical interventions
Discusses a range of three Breakaway studies, after learning breakaway techniques. Most of the violence is within the elderly population yet most of the techniques are not appropriate for the elderly.
Discusses the third study that occurred at Broadmoor Hospital – they had a one day breakaway course, 21 different techniques taught that day, the techniques individually had 5 components – so staff somehow have to recall all these component parts – shares the difficulty in training in this area.
*We must remember that we need to look at both staff and patient risks.
Discusses the luxury of civil servants re policies but need to think about the people that are actually on the ground. Discusses the complexity of the area – simple policy statements need to be followed thru – we need an honest debate and that will be uncomfortable – the tension of protection patients and staff, do we use enough security staff, should we consider mechanical restraints?.
What can replace seclusion and restaint? more re escalation and de escalation training, environmental changes, quiet rooms, reduce overcrowding, judicious use of medication, we do have national guidance and that is something we do have right.
Get more information on NICE here http://www.nice.org.uk/CG25
Questions
1. Do all UK hospitals have their individual training in this area?
We used to have a lot of training providers but now we have core curricula and our providers are better – it is a herculean problem, if you look at Australia you will have a problem with training there is insufficient training, some have no training, some need refresher training, discusses the time it takes to get training done well – do the maths.
2. You mentioned the police doing the restraints, are nursing still doing restraints in UK?
Yes nurses still doing most of the restraints, you need to also think of this as a rapidly changing seen and what people expect, you need to think if you employ security staff then you cannot employ the nurses as well due to cost constrainsts.
3. There seems to be emerging conundrum regarding human rights and seclusion and restraint
Yes there are a range of human rights issues – the answer is that you need to look at it on case by case basis and yes it is difficult
4. How important is in the list of priorities re cultural training in this area?
In the UK we have a great cultural mix and awareness in staffing, but in some areas yes there is a real issue regarding cultural differences so we have problems things are getting better but there is a long way to go with regard to this.
More questions from the floor……………….
*Session finishes*
