Eliminating Supine Restraint: Improving Safety with Safety Pods

1. Main title slide page Co-brand logo here ELIMINATING SUPINE RESTRAINT: Improving patient and staff safety using Safety Pods Sarah Trute – Qi Lead for LD & Rehab, Surrey & Borders Partnership Trust Welcome

2. Situation Welcome Main title for slide set Optional sub title or name Restrained too long in an unsafe position… Play up to 1.52 https://www.youtube.com/watch?v=jSahHy_A2TY ifwe don’t move away from poor practices people will continue to be traumatised, get injured, or die

3. Background Welcome Main title for slide set Optional sub title or name Plethora of reducing restrictive practice guidelines available: Learning Disability Mortality Review; NICE guidelines NG10 violence & aggression; short-term management in mental health, health and community settings: 1.4.24 when using manual restraint, avoid taking the person to the floor but if it does become nec. use supine (face up position) or if prone (face down) shortest time possible/promoting choice and dignity. Data: National picture / Learning Disability Mortality Review (LeDeR) statistics.

4. Background Welcome Main title for slide set Optional sub title or name Qi Project Use of Safety Pod: Restraint reduction The Deacon Unit is a 10-bed inpatient facility for people with a LD/MH who require crisis mental health support. (Epsom)

5. Safety Pod impact • The Safety Pod was introduced as a QI Project June 2018. • We tested the effect on patient and staff safety, as well as impact on ground restraints. • There have been no supine restraints since the introduction of the Safety Pod.

6. Assessment AIM PRIMARY DRIVERS SECONDARY DRIVERS Welcome Main title for slide set Optional sub title or name

7. D DATA FEEDBACK TO FRONTLINE STAFF S P A A P S D D S P A A P S D A P S D PDSA Testing Ramps for…. Cycle 6. Next Steps: Scale & Spread … Cycle 5: Safety Pod Datix & Recording Cycle 4: Training developed & delivered Purchase, Maintenance & Contract of Safety Pods Cycle 3: Care Planning & Risk Assessments Cycle 2: Cycle 1: Staff Experience - Confidence Questionnaire

8. Measurement Welcome Main title for slide set Optional sub title or name OUTCOME: No. of supine restraints per month PROCESS: % Perceived Safety & Ease of applying PI using Pods by Staff

9. Safety Pod impact • The Safety Pod was introduced as a QI Project June 2018. • We tested the effect on patient and staff safety, as well as impact on ground restraints. • There have been no supine restraints since the introduction of the Safety Pod.

10. Training Team Input • Safety Pod purchased • Entire staff team and MDT received initial training • On-going remote support and advice • On-site visits for problem solving / address concerns • Regular and on-going refresher training

11. Case Example • 20 yr male, displays high levels of SIB: blinded himself in one eye, multiple detachments in other eye. • Would repeatedly bang his head on the floor during supine restraints • 5 staff members were involved in each supine restraint. • Staff found this challenging - lead to multiple patient and staff injuries. • Young man now chooses to sit proactively in the Safety Pod for deep pressure feedback. • Can be supported safely by 2 members of staff – sometimes requiring a third person to support with the leg guard. • On average, No. restraints have halved, compared to previous admission.

12. Staff survey – pre and post questionnaires

13. Quantitative Data Welcome Main title for slide set Optional sub title or name

14. Qualitative Data I have never seen a new practice enhancement be taken up so quickly with as much consistency as the safety pod, it is easy to use and has made a positive impact to both patients and staff - Manager Welcome The safety pod encourages better communication and more positive interactions when a patient is being restrained. It enables you to have good eye contact at the same level as the person rather than looking down at them – Staff Nurse Main title for slide set Optional sub title or name The safety pod has increased the safety for both the patient and staff during restraints and seems much more dignified than supine restraints – Support worker Safety pod is good, it feels comfortable and is very relaxing - Patient

15. Scale & Spread • Deacon ordered 3 more pods and leg guards • Interest by 4 other MH Inpatient Wards (PICU, acute, dementia, independent living) • X20 Safety Pods order placed for trial across SABP

16. Benefits to others • Enhanced safety of PI (patients & staff) • Better staff confidence • Improved patient experience (dignity, coms, sensory - effective tool for de-escalation via sensory feedback,) • Reduced staffing requirements for PI • Maintains therapeutic relationship • Reduces physical and medical risk/harm/injury Welcome Main title for slide set Optional sub title or name

17. Recommendations: Welcome Main title for slide set Optional sub title or name • Barriers and challenges considerations: • Training - Skilled and specific • Culture - Not seen as a ‘restraint chair’ • Spread - Acute Care forum: enthusiasm to spread - but is it Qi? • Maintenance of Safety Pod - location!!

18. Key Improvement Message Welcome Main title for slide set Optional sub title or name The use of a Safety Pod eliminated the need for ground restraints Co-brand logo here