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

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... Prevention and Therapeutic Management of Violence in mental health Care (20002) ... DEVELOP APPROACHES TO ETHICAL, LEGAL AND PROFESSIONAL ISSUES NOT DEALT WITH BY ... – PowerPoint PPT presentation

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


1
The NIMHE/NPSA Violence Project The 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 issues for
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
Manager NIMHE/NPSA Tel 07801 557 897 Email
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
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