EPSO working group on Restraints and Coercive Methods in health care

1. EPSO working group on Restraints and Coercive Methods in health care M.E.W.(Thijs) Melchior , RN, PhD coordinating/specialized senior inspector me.melchior@igz.nl www.igz.nl

2. PRESENTATION OUTLINE • Why focus on reduce and prevent unnecessary restraints and coercive methods? • Working group • What have we done? • Future activities • Pilot • Discussion & questions

3. WHY FOCUS ON REDUCE AND PREVENT UNNECESSARY RESTRAINTS AND COERCIVE METHODS? • Impact on the five D’s : • Death, disease, discomfort, dissatisfaction, disability • Quality of life • Less restrictive alternatives available • Good focus on reducing and preventing unnecessary restraints and coercive methods = client centered care

4. WORKING GROUP MEMBERS Eve Pilt, chair, Terviseamet (Estonia) Anja Jonkers (IGZ Netherlands), Thijs Melchior (IGZ Netherlands) Marjolein van Vliet (external expert) Vilans) Theresa Nixon (Northern Ireland) Rosemary Smyth Krist Debruyn, Zorginspectie (Flanders) Hanna Ahonen (Valvira, Finland) Jooske Vos, Dirk Meijer (EPSO).

5. WORKING GROUP General goal: Reduce and prevent unnecessary restraints and coercive methods in health care and social care in the EPSO member countries What have we done All members of EPSO were asked to fill in a questionnaire to explore the topic of restraints and coercive methods in their country (presented at the EPSO conference in Utrecht October 2012). A framework was made that would be useful for supervisory and monitoring organizations in carrying out their supervisory tasks concerning to reduce and prevent unnecessary restraints and coercive methods (first presented at the EPSO conference in Brussels April 2013).

6. THE FRAMEWORK Minimum standards for supervisory or monitoring organisations necessary to deliver good and adequate supervisory and monitoring activities on restraints and coercive methods in health care and social care. Minimum standards for (health) care providers: What should a (health) care provider or health care organisation do to avoid applying restraints and coercive methods in the first place and how can they be applied in a responsible and justifiable manner in the case of medical necessity?

7. PILOT OF THE FRAMEWORK • Are the standards useful and adequate for the supervisory authority or monitoring organisation to reduce and prevent unnecessary restraints and coercive methods? What approach and methods should be used to make care providers interested? • Are the standards useful to evaluate the quality of the care with regard to reducing and preventing unnecessary restraints and coercive methods in health care organisations

8. METHOD (1) • The EPSO member of the country where the framework is being tested asked three different kinds of health care organisations (nursing home, home for mentally handicapped people and general hospital) if they would participate in the pilot. Participation is voluntary. • Each health care organisation receives a brief report of all the findings. The health care organisation is anonymous in the report. • The pilot will be carried out by three members of the working group. One member of the EPSO country where the framework is being tested participates in the pilot and acts as a translator if necessary.

9. METHOD (2) • The pilot group conducts interviews with the general manager of the health care organisation, the manager of the ward where the pilot takes place, members of the nursing staff, the doctor, psychologist and clients or the representative of a client. • The health care organisation selects the wards where the pilot takes place and arranges the members of staff (and possibly other people) to be interviewed by the pilot group. • The pilot group assesses relevant documents and care plans of the clients. The clients or the representatives of clients must grant permission in advance for the pilot group to assess the care plan • The members of the pilot group and the staff of the health care organisations where the pilot is carried out evaluate the suitability of each standard. • The pilot group interviews at least two members of the supervisory organisation and assesses relevant documents.

10. DISCUSSION & QUESTIONS