Blanket Restrictions
A blanket restriction refers to the rules or policies that restrict a patient’s liberty and other rights, which are routinely applied to all patients, or classes of patients, or within a service, without individual risk assessments to justify their application. This care bundle describes six actions to ensure the best clinical outcome for patients who have been subject to a Blanket Restriction.
Each described intervention will be required to be delivered, however these do not need to be completely sequentially.
Aim:
Each ward area will operate procedures and protocols that match the needs of the service user group, to ensure therapeutic progress whilst minimising risks.
What to do:
Confirm (and re-affirm during stay) information on ward routine/activities/therapies/domestic arrangements i.e. Information on admission; ward posters; community meetings; MDMs etc.
Pre-emptively consider reasons for requiring Blanket Restrictions such as lack of information, lack of understanding, unmet treatment needs, criminal behaviour, environment factors, lack of current resources.
Aim:
Ensure timely and accurate record keeping. Develop robust systems for the implementation of Blanket Restrictions.
What to do:
Ensure all staff involved in the implementation of Blanket Restrictions have access to super-vision and any learning needs are addressed.
Clear documentation on EPR:
- Rationale for the use of Restriction.
- Discussion/reviews with patient of care plan.
- Discussion/updates with other patients affected by Blanket Restriction.
- Discussion/reviews with MDT
DATIX to be completed for all incidents involving Blanket Restrictions.
Update and review the clinical documentation regularly including the care plan and risk assessment.
The ASM should keep a register of blanket restrictions in place.
Aim:
Safe management of Blanket restrictions which is proportionate to the risk and is the least restrictive option and for the shortest possible time.
What to do:
Inform patients, carers and visitors of implementation of Blanket restriction.
Organise MD Team clinical discussion of the type, rationale for and (expected) duration of Blanket Restriction.
Inform senior staff (ASM/ Bleep holder/Ward Manager) of need to implement restriction.
Complete care plan for patient whose presentation is rationale for Blanket Restriction
- Why restriction manages risk.
- Strategies aimed at preventing behaviour escalating.
- Active strategies to remove restrictions.
- The indicators that risk has re-duced to remove restrictions.
Clinical review within 24 hours including Nursing staff and medical team to review care plan, current management plan and future plans to manage risk including alternatives to Blanket Restriction.
Refer to complex case panel.
Inform Day area/HUB/OT of Restriction to allow for “drop in” activities to be accessed.
Assess capacity of other patients understanding of their rights to movement/ access whilst a blanket restriction is in place.
Complete capacity assessment on EPR.
Review and update risk assessment.
Aim:
Foster a multi-disciplinary approach to care planning for Blanket Restrictions to manage challenging behaviour.
What to do:
Team to review Blanket Restrictions decision continuously using criteria in care plan.
Formal discussion each handover to be documented using criteria in care plan.
Clinical review every 24 hours including Nursing staff and medical team to review care plan, current management plan and future plans to manage risk including alternatives to Blanket Restriction.
Feedback from clinical review to be included in care plan and risk assessment.
Formulation of risks to assess the continued need for the Blanket Restriction to remain in place and explore possible alternatives.
Assess effectiveness of current care plan – consider onward referral.
Ongoing review of management and routine treatment and any possible interactions.
Aim:
Develop a robust system that ensures that the patient’s psychological and emotion wellbeing is monitored.
What to do:
MD Team to include in next (and subsequent) MDT reviews, active measures to assess and promote
- Psychological and emotional impact of Blanket Restriction
- Protection of Family and private life (article 8)
- Capacity to consent to remain (informal patients)
- Active plans to reduce/remove Blanket Restrictions.
On all patients affected by Blanket Restriction.
Liaise with Hub/OT Day area for ward based activity.
Consider level of support required by staff/patient/other patients following any incident that preceded the implementation, for psychological impact and physical injuries.
Monitor capacity of other patients understanding of their rights to movement/ access whilst a blanket restriction is in place.
Liaise with Hub/OT Day area for ward based activity.
Consider discharge and Home treatment, and transfer options for any patient adversely affected by Blanket Restrictions.
Aim:
Support the patient and carer(s) following Blanket Restrictions and support all involved to develop under-standing of why the restriction where implemented.
What to do:
MD team including ASM/Matrons/HoN should review the team approach and reflect upon why / when / how the blanket restriction was applied and the circumstances that led to, and continued the need for, Blanket Restrictions with the patient, carer and/or advocate and signpost to additional support.
Review the positive behavioural support plan, advanced directives and other clinical documentation.
Ensure patient and staff are given the opportunity to reflect on their experience of the Blanket Restriction.
Feedback from debriefs to be included in care plan and risk assessment.
Ensure all staff involved have access to supervision.
Identify training needs.