Assignment: Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process

RE: Group B Practice Experience Discussion – Week 2 


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Use of Restraints and Seclusion in Children and Adolescents

The Department of Health has issued advice on using positive and proactive techniques to foster a culture in which physical interventions are only required as a last option. Several reports have focused on the misuse or abuse of restrictive interventions in health and care services. Restraint reduction aims for schools, hospitals, and human care agencies devoted to properly controlling agitated behavior. In healthcare, The Joint Commission has its Elements of Performance in place addressing the use of the physical constraint. CPI’s training and tools can assist you with constraint reduction in education, healthcare, or human services.

Nonviolent Crisis Intervention training from CPI teaches hospital personnel de-escalation methods and various alternatives to restraint. The training programs follow The Joint Commission and CMS requirements. Select personnel can be qualified to teach the curriculum to other professionals on an ongoing basis using the train-the-trainer option. According to the MHA Code of Practice 11, health and care providers must ensure that their staff is adequately educated in the confinement of mentally ill patients. Implementing restrictive measures in community-based health and social care services and non-mental hospital settings is very seldom authorized under the Mental Health Act of 1983 (MHA) 18 (Cummins, 2020). The use of force is only justified in self-defense, defense of others, criminal prevention, property protection, or property protection.

In my practice setting, I interviewed Peter Shumaker, Risk Manager who reiterated how we are continually educate staff on the approve Restraint method which is CPI ( Crisis Preventive Intervention). We have  four different trainers who complete the re-education in tandem with the staff educator to ensure interrater reliability. According to Peter, the Risk Manager Department completes a review of each restrictive intervention to ensure that the restrictive intervention is meeting not only Hospital policy but regulatory requirements as well. If that restraint does not meet regulatory or Hospital policy, the staff member responsible is subject to corrective actions up to termination.

Transparent rules and governance mechanisms must be developed in England, Wales, and Northern Ireland to guarantee transparency surrounding restrictive treatments for mental health patients. Restrictive interventions may constitute assault or battery (if the individual has the mental capacity to oppose what is offered), intentional neglect or ill-treatment of persons lacking mental capacity (an offense under section 44 of the MCA14), or unlawful loss of liberty. Restrictive interventions should always be the least restrictive alternative available to satisfy the person’s current need. They should be scheduled as far ahead as feasible to be documented in a behavior support plan (or similar) and contain both primary and secondary methods. During any period of restraint, a staff member should assume responsibility for talking with the individual to seek to deescalate the situation constantly. Staff shall not intentionally inflict pain on a patient to coerce compliance with their instructions. There must be no deliberate or purposeful restriction of a person in a prone/face down posture on any surface, not only the floor. People must not be confined on purpose in a way that interferes with their airway, breathing, or circulation.

Chief Operation Officer, Paula Roberts, RN was also interviewed and added that on a weekly bases, the Behavioral Committee, meets to discuss “high flyers” and other behavioral issues the patient might be having and use therapeutic supports to help patients and safely avoid the need for a restrictive intervention.

Annual reviews of restrictive intervention reduction programs must be conducted, and they must be made available for inspection by the CQC and Monitor. Any service user who has a behavior support plan that recommends restrictive interventions should have clear, proactive strategies in place. The principles of the Programme for British Standards must be followed when providing care (PBS). The Care Quality Commission (CQC) has created a robust registration, regulation, and inspection system that holds businesses and NHS boards accountable for care failures (Smithson et al., 2018). According to the CQC, physical interventions are risky and put both staff and service users at risk of bodily or mental damage. Restriction intervention reduction programs must be implemented in services based on the concepts of effective leadership, data-informed practice, workforce development, and service user empowerment. A yearly assessment of control measures is required to revise and update corporate action plans. Any service user who has a behavior-support plan that recommends restrictive measures should have clearly defined proactive tactics.

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measurable data collected

After speaking with Risk Manager, Peter Shumaker, this is the information I was given. Peter goes on to say that this is data that would also be shared with Joint Comission

Cumberland hospital was averaging between 110 to 130 restrictive interventions a month. In the time range of 3qtr 2020 to 1st qtr. 2021 Cumberland Hospital was able to drop their restrictive intervention rate by 25% by using the following.  

1.       Completing Camera reviews for each restrictive intervention.

a.       This assisted in seeing patient and staff interaction and if the restrictive intervention was justified (i.e. was their immediate risk of harm to self and others) .

b.       If the restraint was complete per policy and procedure (excessive force was not used)

2.       If excessive force or unneeded restrictive interventions we used we would do the following

a.       The staff member would be reported to the correct regulator agency – this occurred for 20% of restrictive interventions in the 4th QTR

b.       After the report was made an investigation would occur  for all reported incidents – Of those incidents 13% were found to be excessive or unneeded to the point that led to termination.

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