93 A Multidisciplinary Approach to Restrictive Interventions in Residential Care

Background A residential service in Dublin is home to 100 older persons with wide-ranging, complex care requirements. Traditionally restrictive interventions (RI) for residents in the setting were the decision of the Nursing/Medical team. Evidence based best practice stipulates that RI must be supported by a systematic and collaborative assessment between the resident, their family/representative and members of the multi-disciplinary team (MDT). Thus, the MDT identified a need for a change in practice in respect of RI and to facilitate formal MDT discussions regarding the assessment, introduction and review of RI for individual residents. Methods A Restrictive Interventions Working Group (RIWG) was set up to facilitate an overall change in practice in respect of RI. The working group developed pathways for planned/emergency RI with particular focus on the development of a Planned RI form to guide MDT discussion. The pathways were implemented across the service. The RIWG drafted a new RI Policy to reflect the changes in practice, followed by education sessions facilitated by Occupational Therapy and Practice Support. Feedback was sought after each education session. Results The project was launched on August 1st 2018. Sixteen Planned RI Forms were presented to MDT from August 2018 to February 2019. Seven of those restrictions were discontinued following MDT discussion. 43% reduction in mechanical RI and a 54% reduction in PRN psychotropic prescription between August and December 2018. Staff reported the education sessions as being `very informative', `relevant to the setting', `allowed us to think about the key issues we face in our day to day work' and `improved my understanding of RI and the best practice approach'. Conclusion An MDT forum for discussing RI provides improved governance over the introduction, review and discontinuation of RI. Further education in respect of RI, management of responsive behaviours and staff competency assessment will further improve practice, with the goal of achieving a RI free home.