Quality statement 10: Review of restrictive interventions

Quality statement

People with a learning disability and behaviour that challenges have a documented review every time a restrictive intervention is used. [2015]

Rationale

Restrictive interventions should be used as a last resort and decisions to use them should be based on the principle of using the least restrictive intervention necessary. Documented risk assessment and review of restrictive interventions helps to ensure learning. This will reduce the use of future restrictive practices, identify and mitigate any risks associated with their use and ensure safety, dignity and respect for people with a learning disability and behaviour that challenges. A documented review will also help to ensure that people with a learning disability and behaviour that challenges and their families or carers understand why and when restrictive interventions could be used.

Quality measures

Structure

Evidence of local arrangements and written protocols to ensure that people with a learning disability and behaviour that challenges have a documented review every time a restrictive intervention is used.

Data source: Local data collection.

Process

a) Proportion of people with a learning disability and behaviour that challenges who receive a restrictive intervention.

Numerator – the number in the denominator who receive a restrictive intervention.

Denominator – the number of people with a learning disability and behaviour that challenges.

Data source: Local data collection.

b) Proportion of people with a learning disability and behaviour that challenges who have a documented review every time a restrictive intervention is used.

Numerator – the number in the denominator who have a documented review every time a restrictive intervention is used.

Denominator – the number of people with a learning disability and behaviour that challenges who receive a restrictive intervention.

Data source: Local data collection.

Outcome

Rates of restrictive interventions.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as secondary care services, social care providers and providers of residential care) ensure that systems are in place for people with a learning disability and behaviour that challenges to have a documented review every time a restrictive intervention is used.

Health and social care practitioners (including staff in residential settings) ensure that people with a learning disability and behaviour that challenges have a documented review every time a restrictive intervention is used.

Commissioners (such as clinical commissioning groups, NHS England and local authorities) ensure that they commission services that carry out a documented review with people with a learning disability and behaviour that challenges every time a restrictive intervention is used.

People with a learning disability and behaviour that challenges who are stopped from moving around (for example, by being held or given an injection of medication) should have a review of how this was carried out and whether it was needed or could have been avoided. A review should help the person understand when and why this approach is used. A review should also make sure that the approach used restricts the person as little as possible.

Source guidance

Challenging behaviour and learning disabilities (2015) NICE guideline NG11, recommendations 1.9.3 and 1.9.6

Definitions of terms used in this quality statement

Restrictive intervention

Interventions that may infringe a person's human rights and freedom of movement, including locking doors, preventing a person from entering certain areas of the living space, seclusion, manual and mechanical restraint, rapid tranquillisation and long‑term sedation.

[NICE's guideline on challenging behaviour and learning disabilities]

Documented review of restrictive intervention

Use of a restrictive intervention should be accompanied by a documented review that includes the following:

  • review of the delivery and outcome of the restrictive intervention, whether it was needed and how it could be avoided (and if so, what action will be taken)

  • assessment of the safety, efficacy, frequency of use, duration and continued need for reactive strategies

  • involvement of everyone who cares for the person with a learning disability, including their family members and carers, and the person themselves, if possible.

[Adapted from NICE's guideline on challenging behaviour and learning disabilities, recommendations 1.9.3 and 1.9.6]

Behaviour that challenges

Behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or physical safety of the person, or others around them. It also includes behaviour that is likely to severely limit, or result in the person being denied, access to and use of ordinary community facilities.

[Adapted from NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, terms used in this guideline]

Equality and diversity considerations

The communication needs of people with a learning disability, particularly the needs of people who are unable to communicate through speech, should be taken into account in a health assessment. Practitioners may need to provide support for those who have limited speech and for those who have difficulty with English.