Reducing Restrictive Practice programme

The Reducing Restrictive Practice (RRP) collaborative is part of a wider Mental Health Safety Improvement Programme (MHSIP) which was established by NHS Improvement (NHSI) in partnership with the Care Quality Commission (CQC) in response to a request made by the Secretary of State.

The aim of the RRP is to reduce restrictive practice (measured by number of restraints, seclusions and rapid tranquilisations) by 33% in the wards that are selected to take part.

In order to meet this aim, the programme will work to:

  • Design the programme in collaboration with experts and experts by experience
  • Provide tools and resources for selected wards to develop their own quality improvement plans
  • Support wards to carry out quality improvement through bimonthly learning days and dedicated Quality Improvement Coaches

Programme resources

Tools and resources for change ideas

For most of the change ideas in the Reducing Restrictive Practice driver diagram, there are resources below to assist you in your quality improvement initiatives.

If you would like to learn more about the tools or talk through how they can be applied in practice, the individuals listed in the ‘contact details’ column are happy to be contacted if you would like to discuss more.


Dynamic Appraisal of Situational Aggression (DASA)

Tool and resources

A tool to assess the likelihood that a service user will become aggressive within an inpatient environment.

This is helpful to use with service users and patients can add their specific triggers

Contact details for further information

BROSET Violence Checklist

Tool

http://riskassessment.no/

Contact details for further information

Tool: Co-produced posters

Contact details: Jack Pooler (Central and North West London NHS Foundation Trust) jack.pooler@nhs.net

Tool: NTW Dashboard

Contact details:  Ron Weddle (Northumberland, Tyne & Wear NHS Foundation Trust) ron.weddle@ntw.nhs.uk

Tools: Training materials to support running dashboard + data and user guides

Contact details for further information

Tools: Talk First

Talk First incorporates:

Contact details for further information

Mark House (Northumberland, Tyne & Wear NHS Foundation Trust) mark.house@ntw.nhs.uk

Tools: 4 Steps to Safety Storyboard

Template to allow wards to report their progress at collaborative events: 4 Steps to safety

Contact details for further information

Tools: NTW dashboard

NTW dashboard and annual projection data.

Contact details for further information

Tool: PROactive Governance of Recovery Settings and Services

Contact details for further information

Tool: REsTRAIN Yourself

Includes Developing a learning system in local services, and Ward culture audits.

Contact details for further information

Tool: RESPECT Training 'No pain, no panic'

Contact details for further information

 

Tool: PROactive Governance of Recovery Settings and Services

Contact details for further information

Tool: IHI Open School

Online courses and videos in quality improvement methods 

Contact details for further information

Tool: REsTRAIN Yourself

Includes developing a learning culture system in local services, and Ward culture audits.

Contact details for further information

Tool: NTW Dashboard Data

Contact details for further information

Tool: Staffing completing own WRAP plan

Wearing two hats - group for staff with mental health issues

Contact details for further information

Tool: Staff networks 

Staff support services e.g 'Staying well at work service'

Contact details for further information

Tool: No Audit: Reflect to Reframe

  • Download the document Training resources and Audit tool.

Contact details for further information

Tool: PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare

Contact details for further information

Tool: PROactive Governance of Recovery Settings and Services

Contact details for further information

Tool: PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare

Contact details for further information

Tool: PROactive Governance of Recovery Settings and Services

Contact details for further information

Tool: REsTRAIN Yourself

Includes developing a learning system in local services, and Ward culture audits.

Contact details for further information

Tool: Full time Prevention and Management of Violence and Aggression (PMVA) Members with lived experience and training

Contact details for further information

Tool: WLMHT PMVA Instructional Team

Contact details for further information

Tool: Maudsley Simulation

Contact details for further information

Tool: RESPECT Training 

Contact details for further information

Tool: TEWV NHS Trust training plan

Contact details for further information

Tool: REsTRAIN Yourself

Includes developing a learning system in local services, and Ward culture audits.

Contact details for further information

Tool: De-escalation techniques (Northumberland, Tyne & Wear NHS Foundation Trust)

Contact details for further information

Tool: PMVA Training

  • Mersey Care Training
  • NTW Training

Contact details for further information

Tool: Peer support PMVA tutors 

Includes Job description for Peer Tutor for TMVA- Band 4 and Peer Recovery Trainer in TMVA.

Contact details for further information

Video:  Learning from Success in Shared Decision Making

 Tool: A bite-sized summary of CLAHRC research: Co-production in the PROMISE study

Contact details for further information

Tool: Safewards

What matters to you exercise for staff and patients (based on Safe Wards mutual expectations) www.safewards.net 

Contact details for further information

Tool: The impact of reducing restrictive practice on Springbank Ward

Contact details for further information

Tool: Service-user focus in all aspects of work and ward-based developments

Contact details for further information

Tool: Social media – sharing best practice globally

  • Facebook – Talk1st  
  • Twitter - @Talk1stNTW
  •  Instagram - @Talk1stNTW 

Contact details for further information

Tool: Is restraint a ‘necessary evil’ in mental health care? Mental health inpatients’ and staff members’ experience of physical restraint

Wilson, C, Rouse, L, Rae, S & Kar Ray M (2017) Is restraint a ‘necessary evil’ in mental health care? Mental health inpatients’ and staff members’ experience of physical restraint International Journal of Mental Health Nursing Oct; 26(5): 500-512

Contact details for further information

Tool: Mental health inpatients’ and staff members’ suggestions for reducing physical restraint: A qualitative study 

Wilson, C, Rouse, L, Rae, S & Kar Ray M (2018) Mental health inpatients’ and staff members’ suggestions for reducing physical restraint: A qualitative study Journal of Psychiatric Mental Health Nursing April; 25(3): 188-200 

Contact details for further information

Tool: Advance Directives

Contact details for further information

Tool: Letter for Later

Emotional wellbeing passports/wellbeing and recovery action plans

Contact details for further information

Tool: CWP NHS FT have developed lived experience connector roles, first linked with nursing associates, now expanding to other groups including board

Contact details for further information

Tool:  Recovery courses

Contact details for further information

Tool: TEWV Positive Behaviour Support Framework

  • Training resources 

Contact details for further information

Tool: Training Courses

Contact details for further information

Tool: BILD Resources – the Centre for Advancement of Positive behaviour Support (CAPBS)

Visit the BILD website.

  • PBS Coaches programme.
  • Practice Leadership training course.
  • Various PBS training courses for staff at all levels and roles.
  • Restrictive Practice Audit and Reduction tool.
  • Best Practice guidance on the use of restrictive practices. 

Contact details for further information

Tool: Values & Attitudes training (Northumberland, Tyne & Wear NHS Foundation Trust)

Contact details for further information

 

Tool: Reducing restrictive practice: Developing and implementing behavioural support plans 

Contact details for further information

Tool: Personal Behavioural Support plans (Northumberland, Tyne & Wear NHS Foundation Trust) 

Contact details for further information

Tool: Realizing nursing: a multimodal biopsychopharmacosocial approach to psychiatric nursing 

Clarke, LL & Clarke, T (2014) Realizing nursing: a multimodal biopsychopharmacosocial approach to psychiatric nursing Journal of Psychiatric Mental Health Nursing Aug:21(6): 564-71 

Contact details for further information

Tool: 4 Steps to Safety for staff and patients

  • Poster/cards representing the toolkit designed by those with lived experience

Contact details for further information

Tool: Relational Security Explorer

Contact details for further information

Tool: Reducing restrictive practice in adult services: not only an issue for mental health professional

Hext, G, Clark, L & Xyrichis, A (2018) Reducing restrictive practice in adult services: not only an issue for mental health professionals British Journal of Nursing Vol 27 No 7 pp 2-7

Contact details for further information

Tool: Safewards

Contact details for further information

Tool: Open Door

Contact details for further information

Tool: SBAR Handover Poster

Contact details for further information

Tool: SBAR/D Templates

Contact details for further information

Tool: REsTRAIN Yourself

Includes developing a learning system in local services, and Ward culture audits.

Contact details for further information

 

 

 

Tool: 4 Steps to Safety for staff and patients  

  • Poster/cards representing the toolkit designed by those with lived experience

Contact details for further information

Tool: 4 Steps to Safety booklets

Contact details for further information

Tool: Cohot Model NTW 

Contact details for further information

Tool: SBAR Handover Poster (part of 4 steps poster designed by team)

Contact details for further information

Tool: SBAR/D handover templates

Contact details for further information

Tool: SBAR clinical message

Contact details for further information

Tool: REsTRAIN Yourself

  • Download the document REsTRAIN Yourself Toolkit
  • Developing a learning system in local services, and Ward culture audits.
  • PMWA Training NTW

Contact details for further information

Tool: CAMHeleon: A celebration of Child and Adolescent Mental Health (CAMHS) best practice 

Contact details for further information

Tool: REsTRAIN Yourself

Includes developing a learning system in local services, and Ward culture audits.

Contact details for further information

 

Tool: Caring for Carers

Contact details for further information

Tool: Safewards: Know Me Profiles

Contact details for further information

Tool: Open Door

Contact details for further information

Tool: The impact of reducing restrictive practice on Springbank Ward

Contact details for further information

Tool: Safewards

Contact details for further information

Tool: Tukes Project

Contact details for further information

  • Jane Lewington and Jo Keen (NAViGO) 01472 583040

Tool: Willow View Mutual Help Meetings

Contact details for further information

Contact details for further information

 

 

Tool: Reducing restrictive practice in adult services: not only an issue for mental health professionals

 
Hext, G, Clark, L & Xyrichis, A (2018) Reducing restrictive practice in adult services: not only an issue for mental health professionals British Journal of Nursing Vol 27 No 7 pp 2-7

Beyond restraint: Raising awareness of restrictive practices in acute care

 
Hext, G, Clark, L & Xyrichis, A (2018) Beyond restraint: Raising awareness of restrictive practices in acute care International Journal of Nursing Studies

Volume 86, October 2018, Pages A1-A2

Contact details for further information

Tool: A bite-sized summary of CLAHRC research: PROMISE - reducing physical restraint in inpatient adult mental healthcare

Contact details for further information

Tool: Restraint Reduction Network Toolkit

Restraint Reduction Network Toolkit and Training packages

Tool: REsTRAIN Yourself

Includes Developing a learning system in local services, and Ward culture audits.

Contact details for further information

Tool: Is restraint a ‘necessary evil’ in mental health care? Mental health inpatients’ and staff members’ experience of physical restraint 

 Wilson, C, Rouse, L, Rae, S & Kar Ray M (2017) Is restraint a ‘necessary evil’ in mental health care? Mental health inpatients’ and staff members’ experience of physical restraint International Journal of Mental Health Nursing Oct; 26(5): 500-512 
 

Mental health inpatients’ and staff members’ suggestions for reducing physical restraint: A qualitative study 

Wilson, C, Rouse, L, Rae, S & Kar Ray M (2018) Mental health inpatients’ and staff members’ suggestions for reducing physical restraint: A qualitative study Journal of Psychiatric Mental Health Nursing April; 25(3): 188-200 Article in the Journal of Psychiatric and Mental Health Nursing 

Contact details for further information

PROMISE: PROactive Management of Integrated Services and Environments

Research into the reduction of restrictive practice at Cambridge and Peterborough NHS Foundation Trust 

Contact details for further information

Tool: St Charles project at CNWL

Contact details for further information

Tool: Physical health monitoring post rapid tranquillisation audit

Contact details for further information

Tool: Implementation of e-cigarette vending machine on the inside

Download the documents Protocol on the use of electronic cigarettes on trust premises and Smoke free report.

Contact details for further information

Tool: NRT on admission, smoking cessation advice and support

Download the documents Guidance on the use of e-cigarettes in hospital and Key points: e-cigarettes. 

Contact details for further information

Tool: Sleep well pilot NTW

Contact details for further information

 

Tool: Intentional rounding poster

Including Reminders for computer screen.

Contact details for further information

 

Tool: Open Door

Contact details for further information

Tool: Sensory rooms/sensory gardens

  • Hospital rooms – charity working with artists to develop ward space

Contact details for further information

Tool: PLACE Audits (ligature audit tool)

Contact details for further information

 

Tool: Discussion around whether Peer Support Workers are involved in restraint

Accredited training courses and Peer support PMVA tutors

Contact details for further information

Tool: Tukes Membership

Contact details for further information

  • Jo Keen (NAViGO) 01472 583040

Tool: Peer support on wards at Hopewood Park Site

Contact details for further information

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