Reducing Restrictive Practice on a Medium Secure High Dependency Forensic Inpatient Unit

Aims Restrictive practice can include physical and chemical restraint should be utilised as a last resort. It has been found to negatively impact patients causing psychological distress, re-traumatisation, sense of helplessness. also impacts staff, emotional moral conflict the risk harm. Since 2018, there drive reduce restrictive in inpatient mental health wards across England by National Collaborating Centre for Mental Health, which further developed NHS 2021 within Health Safety Improvement Programme (MH-SIP). This study aims on 10-bedded Medium Secure High Dependency Male Forensic Unit over 6-month period, incorporating staff patient feedback utilise QI methodology. Methods Number total seclusion hours, episodes secluded per day were measured at baseline utilising Rio clinical system continuously tracked during period. Interventions discussed multi-disciplinary team including nurses, pharmacists, care assistants, occupational therapists, psychologists, doctors. Patients invited give ward rounds. Potential interventions then implemented PDSA methodology with iterative changes tested analysed. Staff complete surveys semi-structured interviews comments study. Results Baseline data monthly activity showed 3,758 10 5.3 seclusions day. Iterative included; (i) MDT discussions support positive taking (ii) Improved collaborative planning (iii) Incident calendars (iv) excel spreadsheet indicating progress towards leave / referral stepdown (v) improving transparency incidents progress. Month 6 174 hours (95% reduction), 1 episode (90% average (82% reduction). A survey completed end period all either strongly agreed or that they understood process termination seclusion, 100% responding between “neutral" "strongly agree” this had improved. Conclusion was hypothesised more approach could lead reduction practice. The enacted have significantly reduced use Further is recommended into these review if similar results replicated other wards.