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Definition of restraints or coercive methods

Supporting service provider organizations in reducing restraints in The Netherlands Marjolein van Vliet, RN, PhD, Project manager Vilans , C entre of expertise for long-term and social care m.vanvliet@vilans.nl Utrecht, 11-10-2012. Definition of restraints or coercive methods.

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Definition of restraints or coercive methods

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  1. Supporting service provider organizations in reducing restraints in The NetherlandsMarjolein van Vliet, RN, PhD, Project managerVilans, Centre of expertise for long-term and social care m.vanvliet@vilans.nlUtrecht, 11-10-2012

  2. Definition of restraints or coercivemethods All kinds of measures, physicalandverbal, torestrictcliëntsandpatients in theirfreedom of movementandto live their life as wanted. • Thisincludes: belts, paddedcells, individualrulesandengagements, house rules, electronicmeasures, medication.

  3. Case ‘We thought it wasn’t that bad with restraints in our organization. However when we listed them we were shocked to learn that we restrict the freedom of our clients in many ways. We just never realized. For example, clients were allowed to drink coffee at designated places and times and nowhere else. Or a wheelchair which was always parked with the brake on, doors of homes that were always locked. We weren’t happy with these discoveries, so we knew: we have some work to do.’

  4. Framework • Care for Better, large improvement program in long term care in The Netherlands • Initiated and payed for by Ministry of Health • Topics on patient safety and patient autonomy, e.g. medication safety, preventions of falls • Reducing restraints

  5. Background reducingrestraints An increase of severe incidents Report Inspectorate of Healthcare (2008) Declaration of intent (2008) Upcoming new Dutch legal framework (2009)

  6. Reducing restraints In 2008-2012 eight collaboratives 134 teams Aim of project:To prevent or reduce restrictive measures on clients and to apply less severe restraints or alternatives

  7. Participatingservice provider organizations

  8. Results A reduction of 30% - 60% in restraints More client friendly approaches (technology) Client focused approach End of rituals and routines! Great diversity in alternatives Less medication use No increase of falls or aggression

  9. Methods Multidisciplinary improvement teams Analysis of quality criteria Measurements: awareness Exercises to raise awareness Thorough analyzing each individual case Search for alternatives Improvement method: breakthrough, PDSA cycle

  10. measuring= knowing (better) Reducing restraints Instructions

  11. Awareness ‘The first measurement provided useful information. The Geeltjesmeting /sticky pad measure and the analysis of quality criteria provided insight in what we do well and where there was room for improvement. It seemed that staff lacked expertise and the preconditions were poor.’

  12. Outline of the programm • Severalnational conferences in Utrecht • Presentation of good practices • Goal oriented • Learning andsharingknowledge • Evidencebasedand practice based • Improvementmethod, PDSA cycle

  13. Outline of the project Expertmeetings Intakes 2nd working conference 1st working conference Final meeting Kick-off • 1st action period • First measurement and analysis • Improvementplan • Internal kick-off • 2nd action period • Improving • Measuring • Communicating • 3rd action period • Improving • Measuring • Communicating Sustaining & Spreading good practice

  14. Support by project team Vilans E-mail Phone (monthly) Monthly reports Extranet Toolkit Meetings Expertteam/best practices

  15. Discussion: Success and failures • Measure • Communication • Step-by-step (PDSA) • Involving clients and family • Celebrating successes • Thorough analysis • Exchanging experiences Changes in staff Incidents Resources Pressure on organizations Resistance and opposition (both in staff and family)

  16. More information Questions? M.vanvliet@vilans.nl +31 30 789 24 89 +31 6 228 100 10

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