PROMISE delivers reduction in physical interventions says CQC

The Care Quality Commission (CQC) has highlighted how the introduction of a positive and therapeutic culture across mental health wards at CPFT has reduced the need for restrictive interventions. 

PROMISE delivers reduction in physical interventions says CQC
12 December 2017

The Care Quality Commission (CQC) has highlighted how the introduction of a positive and therapeutic culture across mental health wards at CPFT has reduced the need for restrictive interventions. The PROMISE (PROactive Management of Integrated Services and Environments) Project was devised by Dr Manaan Kar-Ray and Sarah Rae. 

The CQC guide is designed to help mental healthcare providers give appropriate support to people whose behaviour might endanger themselves or others.

Sarah Rae, Co-founder of PROMISE and CPFT expert-by-experience, said: “It’s very gratifying to see that over a three- year period there has been a sustained reduction in the use of physical interventions within CPFT. Reflective practice and a positive and proactive approach to care delivery has become business as usual which can only be good for patients and staff.

In March 2016 the Promise Project was named the winner of the Strengthening The Foundation category at the Patient Experience Awards.

Here Sarah Rae describes how PROMISE was developed.

“PROMISE (PROactive Management of Integrated Services and Environments) was conceived in August 2013 with the aim of reducing the use of coercion and restrictive practices on adult inpatient wards within CPFT.

“It aspires to create an environment where staff feel empowered to take a more proactive approach to frontline care delivery. The key driver was to reduce distress for patients who find physical interventions traumatising, especially when prone (face down) restraint is used. Staff also report that using restraint, even as a last resort, is at odds with their therapeutic nursing role.

“There are many aspects to the PROMISE project which are interrelated. These include the development of a governance framework which supports staff to adopt a more imaginative approach to care delivery. There was also a huge amount of work done to improve data quality and changes were made to the incident reporting system which allowed for greater scrutiny of the use of restrictive interventions.”

The project was informed by research, which was funded by the National Institute for Health Research (NIHR) East of England Collaboration for Leadership in Applied Health Research and Care.

Sarah continues: ”One of the early insights on the PROMISE journey was the need to focus on antecedents rather than incidents and shift the emphasis to patient experience. This also gives a more positive message and reduces the risk of challenging situations escalating. Frontline staff came up with a range of initiatives to enhance patient experience and reduce frustration which were shared across the wards. Their enthusiasm and creative approach to patient care was key to the success of the project.”

This ethos led to a culture shift which has helped to ensure that the annual average overall scores in the patient satisfaction surveys were high (between 88% and 85% based on 4,591 surveys April 2014 - March 2017).

Sarah added: “People with lived experience were involved in PROMISE by bringing a patient perspective and providing ideas about the best ways to enhance patient care. This co-produced approach, which was embedded from the start of the project, also contributed to the favourable outcomes.”

During the first three years of the project there has been a marked reduction in the incidence of physical interventions, especially prone restraints in which there was a 58% reduction in the annual total use of prone restraints from 2015/16 to 2016/17.

 

ENDS

Contact details
For more information please contact:
Adrian Ient
Communications Manager
E adrian.ient@cpft.nhs.uk 
T 01223 219470

Cambridgeshire and Peterborough NHS Foundation Trust
Elizabeth House, Fulbourn Hospital
Cambridge, CB21 5EF

T 01223 219400 (open 8:30am to 5pm)
F 01480 398501

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