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PROactive Management of Integrated

Services & Environments

PROGRESS PROCESS PROMOTE PROTECT

Mind launched their restraint campaign in June 2013 with the publication of a report. This report found huge variation in the use of restraint across England. In a single year one Trust reported 38 incidents compared to over 3000 by another. Mind also raised concerns about the face down or ‘prone’ restraint and the number of restraint related injuries - over a 1000 incidents in one year.


It was reading this report, as a Mind trustee, that started Sarah thinking about factors that might influence the use of restraint in her local area. She was curious to learn more about the incidence of restraint at the Cambridge and Peterborough Foundation Trust and to understand how the organisation was working to minimise its use.


Sarah approached Manaan, in August 2013 to discuss the findings in the Mind report. Manaan himself is a keen proponent of Recovery and changing the power dynamics at work was very close to his heart. Towards the end of this meeting they had a brainstorming session, started floating ideas and discussing the possibility of doing a project.


It wasn’t long after their initial meeting that Manaan and Sarah attended a Recovery learning event where they heard Rachel Perkins, Julie Repper and others speak about ways to reduce the need for restraint. They also learnt about the work that some other trusts were doing such as, Dorset and Mersey Care. Hearing these examples of innovative practice acted as a catalyst, crystallising their thoughts and the ideas for the project soon emerged.


Judy, in her head of nursing role also came on board.  She was working on a nursing strategy and was aware of the impact physical interventions had on both patients, staff and the therapeutic relationship. Support from Peter Jones and Ed Bullmore was vital and bought academic rigour to the nascent PROMISE project. CPFT also appointed a new Chief Exec, Aidan Thomas who is very keen on Recovery. His commitment to eliminating reliance on force gave PROMISE the wind in its sails it needed to cast away.


A small multidisciplinary working group was formed and the aims and objectives of the Promise project were clarified. Funding for 1 year was successfully obtained from CLAHRC (Collaboration for Leadership in Health Research and Care) East of England. Support from Iliana Rokkou with her PPI experience and Simon Crick from Research Design Centre was invaluable.


One of the first steps was to take these ideas to clinical staff to get an experiential steer. Manaan and Sarah gave a presentation to the Acute Care Divisional staff in January 2014 to raise awareness of Promise. The other aim was to capture staff views on restraint, as it was important to learn about the experiences of staff who had been involved in restraint and to understand the feelings it evoked.


In April 2014 the Department of Health launch published ‘Positive and Proactive Care: reducing the need for restrictive interventions’. This guidance aims to reduce the use of a wide range of restrictive interventions across health and social care settings and it became another key driver for the project. This bought Learning and Development on board as well as they had to critically analyse the Physical Interventions training the trust provides. Sarah Russell and Stephen Paul formed the key links into this vital department.


The project received a further boost when we organized a number of ward managers and senior clinicians to attend a conference in Liverpool. They came back inspired and engaged the frontline in making changes in the nature of day to day interactions. For example Terry came up with an initiative called ‘Mood and Food’ while Becky rolled out ‘Ready Steady Care.’ Haseena Hussain carried out an indepth review of Datixes (our incident reporting system), a piece of work that was taken forward by Suny Coscione under Tom Spencer’s supervision. Lorna Rouse was employed as a research assistant on the project and she has been mapping all the frontline initiatives. Ceri Wilson was appointed as a Research Associate (in partnership with Anglia Ruskin University) with the primary focus on carrying out the qualitative study.


In the early days the focus was very much on inpatient services and at the sharp end of use of force i.e. physical interventions. Thus the acronym PROMISE stood for PROactive Management of Inpatient Services and Environments. However as the discourse developed it became clear that the use of force is on a continuum and in order to reliably eliminate physical interventions one has to look at all shapes and types of force. Manaan would say that although he has never laid hands on a patient, he is as guilty of using force in his interactions in subtle coercive statements like ‘you know what is going to happen if you do not take your medication.’ The use of force is often with the patients best interest at heart and there was a growing feeling that the best way to eliminate reliance on force is for our services to be so proactive that no one gets so unwell that they have to give up the driving seat. Members of the PROMISE team felt that the opportunities to intervene early and proactively mainly lie in the community since 90% of the patient’s journey is there. Thus the name was tweaked to PROactive Management of Integrated Services and Environments.




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