Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model

As part of the Scottish Patient Safety Programme – Mental Health one of the main drivers was the reduction of harm to patients caused by restraint. The aim of this project was to reduce the number of restraints on our Acute Admissions ward. Through use the of the Improvement Model (PDSA), frontline staff were empowered to implement small tests of change at a grassroots level. This approach has led to frontline staff having ownership of driving the changes on a daily basis within the Clinical area. The use of a restraint data collection tool has been adapted and developed with frontline staff to ensure that the staff have ownership of data collected and is used to facilitate improvement. This data is used to inform the development of our Physical Interventions training. Most recently, following analysis, were able to introduce changes to promote the increased use of de-escalation and a shift from prone restraint to the safer seated restraint position. Patient involvement has been paramount with their inclusion in the debrief process. The information gleaned from the patients is used for staff and patient reflection. This has created a learning environment not only for staff but also patients and carers. Everyone involved is able to identify reasons and triggers and generate ideas to reduce the possibility of another restraint. The use of staff and patient safety climate surveys has ensured that we are constantly monitoring improvements in the feeling of safety amongst staff and patients. Our approach has resulted in a change in the culture of restraint resulting in a sustained reduction of 50% in restraint.