Reducing Handcuff Usage in Medium Secure Services

 8th August 2017

In April 2016, staff from several wards in the Forensic service came together to focus on reducing handcuff usage by 50% by December 2016.

The use of handcuffing was normal safety protocol, mainly used for when transporting patients to and from the secure unit such as to appointments or to court. However, staff felt uncomfortable with these practices. They felt that these procedures were highly invasive and detrimental to the therapeutic relationships with their service users, who also reported feeling stigmatised by them.

In addition to this, transferring patients in this way was costly, as secure transfers were needed and potentially police services too.

The service was keen to find alternatives to try and limit the use of handcuffing where possible. In April 2016 staff from Westferry, Broadgate, Ludgate and Shoreditch ward came together to explore their existing protocols and share ideas about how it could be changed.

The team focused on six key areas of their existing system to focus on to reduce handcuffing:

• Risk of violence
• Electronic Monitoring
• Information & Monitoring
• Service Culture
• Lawful decision making
• Least restrictive practice

At the early stages of their project, the attended a national restrictive practice conference, which allowed them to share learning from other services and develop different ways of less restrictive approaches.

The team met every week to discuss and generate various ideas. Listed below are the change ideas they tested:

1. See, Think, Act-Relational Sec Training
2. Structured Risk Assessments
3. Escort Destination Risk Assessment
4. Robust Monitoring Of Handcuff Usage & Requests
5. Regular Reviews Of Authorisations
6. Management To Approach Of Least Restrictive Practices
7. Video Conferencing With Courts
8. Compliance With CoP: ‘Mechanical Restraint’
9. Electronic Monitoring

Once in the testing phase, they began to run PDSA cycles, introducing different change ideas at each cycle. They continued to use their weekly meetings to discuss learning from their PDSA cycles to refine and drive their project forward.

From testing their change ideas, they found that handcuffing incidents had reduced from 4.66 per week to 1. This was a sustained reduction of over 79%!

Within seven months of commencing, the project had met its intended target aim. Change ideas have been embedded in to routine operational practice and their systems have been established and are now in place to hold gains.

The team are continuing to learn from their experiences and have highlighted some important points for others undertaking a QI project:

• “It was helpful to have a very hands on sponsor, as this allowed the project to always have focus and continue to be on track”.
• “Weekly short project meetings were helpful in allowing the project to remain on track and at the core of our practice”.
• “It’s important to involve patients and staff and get their viewings as this can shed light on the impact the project has on them”.
• “The project allowed for greater questioning of certain procedures and allowed leaders to review some practices”.

The QI project shared their learning and successes at the 2017 Annual QI Conference in London. View their poster by clicking the image below.