Following the publication of reports such as Winterbourne View and Mental Health Crisis Care: Physical Restraint in Crisis, Mersey Care NHS Foundation Trust wanted to improve patient safety and quality of care by reducing the number of occasions of physical restraint or increased medication was used as a response to incidents.
The Trust had a long-standing commitment to a recovery-focused care and piloted the use of No Force First on three wards – adult mental health acute, learning disability and medium secure. Peer support workers were recruited, language was fundamentally changed and care was individualised. Risk assessments were replaced with patient safety plans. Education and training was designed to promote and develop the concepts of No Force First.
The wards involved were encouraged to develop their own changes using driver diagrams and PDSA cycles to identify priority interventions and measure improvement. Small, simple, improvements in quality were implemented and measured for effectiveness. Baseline data on restraint was collated for twelve months prior to implementation and monthly progress was monitored using statistical process control (SPC) run charts.
Organisational commitment to recovery principles was important, for example staff briefing sessions were co-produced and delivered.
All three wards reduced physical and medication-led restraint by 50%. Balancing measures showed seclusion use, service user satisfaction and staff sickness were not negatively impacted by changes. One ward experienced a significant reduction in work-related sickness.
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Connect to the strategic vision and ensure visible support from the Board
Develop a credible evidence base and rationale for improvement
Put in place local champions for change
Involve people who use services in co-production and co-delivery.