The NIMHENPSA Violence Project The 3rd International Conference on the Care and Treatment of Offende - PowerPoint PPT Presentation

Title: The NIMHENPSA Violence Project The 3rd International Conference on the Care and Treatment of Offende


1
The NIMHE/NPSA Violence ProjectThe 3rd
International Conference on the Care and
Treatment of Offenders with a Learning Disability
 Thursday 15th April 2004, University of
Central Lancashire
2
Violent behaviour is observed more frequently in
some people than others

• younger (James et al. 1990),
• violent prior to admission (Conn Lion 1983)
• severe forms of mental illness (Pearson 1986)
• confusional states (Whittington et al. 1996)
• non-compliance with medication (Whittington1996)
• short hospital stays in overcrowded wards
  (Edwards Reid 1983)
• poor staff-patient ratios (Yates 1981)
• increased rates of admission (Adler et al. 1983)
• especially clients with criminal histories and
  personality disorders (Hansen 1996)

3
Analysis of Public Inquiries

• amongst the conditions likely to lead to violent
  incidents was the practice of entrusting large
  numbers of seriously mentally ill patients to the
  care of a few poorly trained staff for prolonged
  periods in a therapeutically impoverished
  environment Martin (1984)

4
Some Staff are Assaulted More Frequently Why?

• Approximately 5 of staff are involved in 20 of
  reported violent incidents
• authoritarian attitudes
• failing to involve medical staff
• poor communication
• demoralization and incompetence
• Younger staff with limited experience (especially
  those on permanent night duty)
• Community nurses
• male nurses with managerial responsibilities were
  particularly at risk.

5
A pressure for Change

• The Standing Midwifery Advisory Committee Mental
  health Nursing Addressing Acute Concerns (SNMAC
  1999)
• UKCC Nursing in Secure Environments (1999)
• UKCC Recognition, Prevention and Therapeutic
  Management of Violence in mental health Care
  (20002)
• Mental Health Act Bi-ennial Reports (1999, 2001,
  2003)
• National Audit Office A safer place to work
  protecting NHS hospitals and ambulance staff from
  violence and aggression (2003)

6
Concerns too much emphasis on Physical
management rather than

• Recognition, prevention and De-escalation
• Organisational, environmental and clinical risk
  assessment
• Risk management
• Care Programme Approach and Care Co-ordination
• The Use of Advanced directives or negotiated care
  plans

7
The Wider Context

• The National Patient Safety Agency (NPSA)
• The Counter Fraud and Security Management Service
  (CFSMS)

8
Commission for Health Improvement Audit Violence
in Mental Health and Learning Disability settings

• Two-year national clinical audit programme to
  support residential services to review the safety
  of the services they provide
• Residential units will gather information from a
  those who live, work, and spend time in the
  residential units where violence is known to
  occur
• measure of usefulness will be whether
  improvements identified through the audit are
  implemented

9
National Institute for Clinical Excellence

• Disturbed (violent) behaviour the short-term
  management of disturbed (violent) behaviour in
  in-patient psychiatric settings.
• Consultation on first draft 21st April - 20th May
• Consultation on final draft 9th July - 13th
  August
• Expected date of issue December 2004

10
About the NPSA

• Established July 2001
• Special Health Authority
• Created to coordinate efforts across the NHS to
  identify and learn from patient safety incidents.
• Share information
• Issue alerts/advice on good practice
• Not a regulatory body and no disciplinary powers
• Not an investigatory body
• No performance management role

11
The NPSA Seven Steps to Patient Safety

• Step 1 Build a safety culture
• Step 2 Lead and support staff
• Step 3 Integrate risk management activity
• Step 4 Promote reporting
• Step 5 Involve and communicate with patients and
  the public
• Step 6 Learn and share safety lessons
• Step 7 Implement solutions to prevent harm

12
NPS National Reporting and Learning System (NRLS)

• First healthcare reporting system on this scale
  anywhere in the world
• IT based system that links with local risk
  management systems via internet
• Rolling out to all 655 NHS Trusts in England and
  Wales by December 2004

13
NPS National Reporting and Learning System (NRLS)

• Feedback to Trusts
• Immediate bounce back upon receipt of records
• Reporting blips
• Local exploration of trends and patterns across
  Trusts providing similar services
• National trends and patterns across
  Trusts/Specialties/Incident Types/etc inform
  national solutions development

14
Understanding the patient safety issuesfor
people with learning disabilities

• 1. Inappropriate use of physical intervention
  (control and restraint) was the number one
  concern for people with a learning disability

15
NPSA Survey Concerns

• People being restrained without having a clear
  understanding of the potential harm this could
  cause.
• Confusion about recommended ways of using safe
  restrictive physical intervention.
• Lack of involvement or consultation with people
  with learning disabilities when planning for
  physical interventions.
• Conflicting policies between the agencies
  providing care leading to different approaches
  being used.
• Physical intervention being the first response
  rather than the last resort.
• Problems recruiting and retaining staff to work
  in services supporting people who are
  challenging.

16
The British Institute of Learning Disabilities
(BILD) Findings

• BILD describe physical intervention as A method
  of responding to the challenging behaviour of
  people with learning disabilities and/or autism
  which involves some degree of direct physical
  force which limits or restricts the movement or
  mobility of the person concerned.
• BILD suggests that 50 percent of people with
  learning disabilities and challenging behaviour
  will have physical interventions used on them at
  some point in their life (British Institute for
  Learning Disabilities website www.bild.org.uk).

17
The NIMHE/NPSA Violence Project
18
KEY OBJECTIVES

• PROVIDE ADVISORY AND CONSULTATIVE SERVICE TO DOH,
  NIMHE, SERVICES AND HEI.
• DEVELOP PROPOSALS FOR ACCREDITATION AND
  REGULATION OF TRAINERS AND TRAINING.
• PUBLISH POSITIVE PRACTICE STANDARDS AND PROMOTE
  AUDIT.
• LINK WITH N.P.S.A. AND OTHER AGENCIES ENSURE
  JOINED UP ACTIVITY.
• UPDATE THE RELEVANT CHAPTERS OF THE MHA CODE OF
  PRACTICE.

19
KEY OBJECTIVES

• CONVENE AN EXPERT STEERING/ REFERENCE GROUP TO
  PROVIDE ADVICE AND DEVELOP APPROACHES TO ETHICAL,
  LEGAL AND PROFESSIONAL ISSUES NOT DEALT WITH BY
  OTHER INITIATIVES
• JOINTLY AGREE PRINCIPLES AND STANDARDS FOR
  EFFECTIVE POLICY, TRAINING, PRACTICE AND PROTOCOL
  DEVELOPMENT WITH A RANGE OF KEY STAKEHOLDERS.

20
KEY OBJECTIVES

• EXPLORE CONCEPT OF COLLABORATIVES FOR PROBLEM
  SOLVING WORKSHOPS, POLICY, TRAINING, PRACTICE AND
  PROTOCOL DEVELOPMENTS.
• IDENTIFY GAPS AND AREAS FOR FUTURE RESEARCH AND
  DEVELOPMENT.
• REVIEW RECOMMENDATIONS FROM INVESTIGATIONS AND
  INQUIRIES PROMOTE LESSONS TO BE LEARNED.

21
POSITIVE PRACTICE STANDARDS
22
POSITIVE PRACTICE STANDARDS

• PREVENTING AND MINIMISING AGGRESSIVE AND VIOLENT
  BEHAVIOUR
• TRUST BOARD RESPONSIBILITIES AND ORGANISATIONAL
  POLICIES AND PROCEDURES
• DEVELOPMENT AND DELIVERY OF EDUCATION AND
  TRAINING 
• TRAINERS EDUCATION AND TRAINING 
• STAFF EDUCATION AND TRAINING 

23
POSITIVE PRACTICE STANDARDS

• PHYSICAL CARE AND OBSERVATION DURING RESTRAINT 
• PEOPLE WITH LEARNING DISABILITY AND MENTAL HEALTH
  PROBLEMS
• SERVICE USER INVOLVEMENT
• FAMILIES AND CARERS INVOLVEMENT
• THE USE OF PAIN TO MANAGE VIOLENCE
• PARTNERSHIP WORKING AND PROTOCOLS

24
POSITIVE PRACTICE STANDARDS

• RECORDING AND REPORTING
• CLINICAL AUDIT AND MONITORING
• POST INCIDENT SUPPORT, REVIEW AND RECONCILIATION
• ENVIRONMENTAL SAFETY
• BLACK AND MINORITY ETHNIC GROUPS
• WOMEN IN MENTAL HEALTH
• AGE AWARENESS

25
IMPLEMENTATION OF POSITIVE PRACTICE STANDARDS

• INTEGRATE INTO CLINICAL GOVERNANCE ARRANGEMENTS.
• LINK TO DAVID BENNETT INQUIRY RECOMMENDATIONS
• TRAFFIC LIGHT AUDIT OF STANDARDS
• REVIEW AND DEVELOPMENT GROUP (KEY STAKEHOLDERS)
• INTEGRATE SYSTEMS, ENVIRONMENTS, POLICIES,
  EDUCATION AND TRAINING PROGRAMMES

26
IMPLEMENTATION OF POSITIVE PRACTICE STANDARDS

• REVIEW COSTS ARE YOU USING AVAILABLE REVENUE IN
  THE MOST EFFECTIVE WAY
• USE COLLABORATIVE APPROACH SHARE POSITIVE
  PRACTICE INITIATIVES
• CONSIDER PILOT OF SPECIFIC STANDARDS (ESSENCE OF
  CARE FRAMEWORK)
• SUPPORT FROM NIMHE

27
Gary OHare Joint Violence Project
ManagerNIMHE/NPSATel 07801 557 897Email
gary.o'hare_at_nmht.nhs.uk
Colin Dale, Joint Violence Project
Manager NIMHE/NPSA Tel O775 246 0992 Email
colindale_at_caringsolutions.fsnet.co.uk