REsTRAIN YOURSELF: Reducing physical restraint within mental health inpatient settings

University of Central Lancashire

  • Led by the University of Central Lancashire (UCLan) and supported by the universities of Liverpool, Leeds and Manchester, and the Advancing Quality Alliance (AQuA).
  • Worked with seven mental health trusts in the north west of England.
  • Aimed to improve patient safety by reducing the level of restraint.
  • Used an adapted version of a quality improvement approach, the Six Core Strategies©, developed in the US, to provide a framework to promote safety at an organisational level.

Physical restraint is used to prevent individuals in mental health services from harming themselves or others. It is only meant to be used as a last resort, but continues to be used routinely, and adverse events have been reported from patients and staff.

This project used an adapted version of the Six Core Strategies© approach that was originally used in the US. The aim of this initiative was to reduce the use of physical restraint by 40% and to improve experience and outcomes for patients.

‘REsTRAIN YOURSELF’ (RY) is designed to challenge staff assumptions and expectations of using restraint. Seven mental health trusts took part in the project, with two acute inpatient wards per trust; one receiving the intervention and the other (the comparator ward) not. The initiative involved monthly reporting, training for ward staff and an improvement adviser offering support, advice and coaching.

Evaluation of the project was carried out by the University of Central Lancashire and involved ethnographic methods alongside quantitative data collection, surveys, interviews and focus groups.

There were 1,680 restraint incidents logged by the trusts over the study period. Four out of the seven trusts exceeded the 40% reduction in restraint target when comparing baseline to either the implementation or adoption phase.

There was a 21% reduction in restraint use overall across the four trusts for whom data was available for the full adoption phase. This reduction was statistically significant compared with changes in the comparator wards. This is particularly noteworthy as it is derived from the final phase of the project where there was no further active support for the intervention. This suggests that RY was successfully embedded into the participating ward cultures and was having an effect on reducing staff reliance on coercive measures.

There was an observable change in the culture of ward teams, with staff noting how the project made them think before using restraint. They also noted a more paced and thoughtful response to self-harming behaviour.

The biggest challenge was the ability of teams to implement changes in an environment of high levels of temporary staff and staff turnover. However, having a small group of champions rather than one lead on each ward reduced the risk of the model not being sustainably implemented.

The project is being run for a further year and is being spread across five wards within each trust in the region.

Contact details

For further information about the project, please email Professor Joy Duxbury, School of Nursing, UCLan.

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