Restrictive interventions recording and data recording: getting it right for people with learning disabilities - Post chat blog

As a Research and Audit Associate in an inpatient forensic learning disability service, I am responsible for completing quarterly audits and an annual report, monitoring progress against our restrictive interventions (RI) reduction plan. I have presented this information to commissioners and regulators, developed audit standards and a tool for assessing the standard of written incident reports, and designed training packages aiming to improve incident recording, and on the use of incident data to improve clinical care. This work can sometimes be challenging; and one evening (probably after a bad day), I began writing down some of the frustrations I encountered. 

These issues include:

• the misrepresentation of restrictive intervention figures in news headlines and reports
• the use of statistics to suggest that RIs are not used as a last resort, over relied upon, or abusive
• wide variation in definitions of RIs used between different care providers / reports 
• failure to record or under-reporting
• focus on whole service / ward rates, with minimal focus on individuals 
• the lack of a National benchmarking process 
• a lack of guidance on how to use data to inform clinical practice.

This was the beginnings of the RI's in in-patient intellectual disability services: How to record, monitor and regulate #letsMonitorRIbetter report, recently published by the Royal College of Psychiatrists. The report was the topic of a Twitter chat on Tuesday 8th January 2018 hosted myself, supported by Paula Richardson & Daniel Marsden. Thirty people (and an unknown number of lurkers) took time out their evening to take part, a combination of; parents / carers, learning disability / mental health nurses, and psychiatrists. I was so glad that the report appeared to be well received by the participants. I had anxieties at various stages of the report’s “journey”; specifically, that I would be perceived as “pro” restrictive intervention. Including the below “Statement of Principles” placed my mind more at ease. 

I was therefore I was therefore quietly pleased when this was neatly summarised by Jonathan Beebee: “...I think the report is brave and necessary. No one wants to use restrictive practices but sometimes they are needed. I think there is a risk of demonising all use of restrictions which can deter from essential adult conversations on this #WeLDNs”. ‏Another useful tweet by Daniel Marsden posed the question : “Did you identify areas of good practice? #WeLDNs” which prompted me to shift focus from problems, to possible solutions. 

Please look at Chapter 4: Recommendations on recording, monitoring and regulation of restrictive interventions (p. 46) which include:

• the initiative to provide more training to staff on writing good quality incident reports which have the potential to contribute to functional analysis
• the use of data to meaningfully feedback into clinical care 
• the “traffic light” audit method. 

I would like to end by thanking all of the report contributors for their valuable feedback, especially the editors, Dr Regi Alexander and Dr John Devapriam. I would also like to thank the WeLDNurses team, especially Paula Richardson, for organising this #weLDNs chat. I hope that the discussion on this hugely important issue continues, and that the report is in some way useful to supporting the aim of restrictive intervention reduction; improving the lives of people with learning disabilities, and their families.