Flip the Triangle: using quality improvement methods to embed a positive behaviour support approach on a medium secure forensic ward for men with intellectual disabilities

BMJ Open Quality

article

Charlotte Whittle¹  George Chingosho¹  Kate Parker¹  Manaal Jama¹  Sidrah Babar¹  Day Njovana¹  Amar Shah¹ 

[1] John Howard Centre , East London NHS Foundation Trust

关键词: quality improvement;    mental health;    patient-centred care;    safety culture;    teamwork;   

DOI  :  10.1136/bmjoq-2021-001514

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Incidents of violence and aggression are serious concerns on a secure ward for people with intellectual disabilities and are often met with increases in physical and restrictive interventions. However, these interventions are usually high risk for both patients and staff and are ineffectual in promoting long-term behaviour change. This study aimed to promote positive culture change and embed the evidence-based practice of positive behaviour support by shifting focus and efforts from the use of physical and restrictive interventions to manage crises to intervening positively and proactively to prevent crises from occurring. The key drivers for change involved increasing access to positive engagement opportunities, expanding the staff team’s repertoire of proactive interventions through training and skill development and supporting staff well-being and resilience. Change ideas occurred alongside a shift in culture that promoted the development of a learning culture, psychological safety and consideration of contextual fit. Quality improvement methods helped the project increase the rate of positive and proactive interventions from 70.65% in December 2018 to 97.18% in January 2020. Increases in staff’s knowledge, confidence and safety were also reported. Lessons and limitations of the project are discussed.quality improvementmental healthpatient-centred caresafety cultureteamworkData availability statementData are available upon request.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND