supporting service provider organizations in reducing restraints in the netherlands marjolein van...
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Supporting service provider organizations in reducing restraints in The
NetherlandsMarjolein van Vliet, RN, PhD, Project manager
Vilans, Centre of expertise for long-term and social care
[email protected], 11-10-2012
Definition of restraints or coercive methods
All kinds of measures, physical and verbal, to restrict cliënts and patients in their freedom of movement and to live their life as wanted.
• This includes: belts, padded cells, individual rules and engagements, house rules, electronic measures, medication.
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.’
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
Background reducing restraints
• An increase of severe incidents • Report Inspectorate of Healthcare (2008)• Declaration of intent (2008)• Upcoming new Dutch legal framework (2009)
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
Participating service provider organizations
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
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
measuring = knowing (better)
Instructions
Reducing restraints
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.’
Outline of the programm
• Several national conferences in Utrecht• Presentation of good practices• Goal oriented• Learning and sharing knowledge• Evidence based and practice based• Improvement method, PDSA cycle
Outline of the project
Plan
Do
Study
Act
Plan
Do
Study
Act
Plan
Do
Study
Act
1st working conference
2nd working conference Final
meetingKick-off
Intakes
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
Expertmeetings
Support by project team Vilans
• E-mail• Phone (monthly)• Monthly reports• Extranet• Toolkit• Meetings• Expertteam/best practices
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)
