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Reducing restrictive practice: seclusion

Reducing restrictive practice: seclusion

Health Innovation Oxford and Thames Valley (HIOTV) is helping to deliver the national Mental Health Safety Improvement Programme: Reducing Restrictive Practice.

Restrictive practices can be traumatising for patients – and staff report very negative feelings around having to be involved in restraint. Minimising the use of restrictive practice therefore brings benefits to patients, staff and the ward as a whole.

We are working with NHS mental health service providers in our region to reduce restrictive practices. This includes intensive work with Oxford Health supporting quality improvement QI projects on five wards.

Restrictive practices are classified as physical restraint, rapid tranquilisation and seclusion. Seclusion is separating the patient from the ward environment and other patients. It should only ever be used as a last resort to manage risk.

By using data and knowledge of their service, Oxford Health’s Kennet ward staff set their QI project aims to reduce the use and duration of patient seclusion. A systematic approach to improvement was used based on the Institute for Healthcare Improvement QI framework – the ‘Model for Improvement’. The project team measured their changes and audited their service.

Kennet’s change idea was a process change – that patients in seclusion must have the decision to keep them in seclusion reviewed at a minimum every Friday afternoon by a multi-disciplinary team. This idea was based on data showing that patients who were in seclusion on a Friday tended to remain secluded until Monday. This led to the ward having very high durations of seclusion.

The changes that were introduced successfully reduced seclusion duration by around two-thirds. Patients benefit as ward practice is now based more on therapeutic need and a regular risk assessment. This improvement is now established as business as usual with seclusions reviewed more often than the mandatory Friday meeting.

HIOTV funded and co-produced a training video based on the Oxford Health Kennet ward QI seclusion project (see link below). This video is being shared with other Oxford Health mental health wards (releasing Kennet ward staff from requests to present to other wards) and outside the trust at QI and mental health shared learning events.