Page 103 - Demo

Implementation interventions through the lens of Normalisation Process Theory1014used, providing the basis for consulting with support staff to consider alternatives. EPOC%u2019s implementation intervention local consensus processes is about inclusion of caregivers in discussions to ensure they agree the clinical problem is important and the approach to managing the problem is appropriate. In starting up the method, consensus processes in various layers of the organisation (from the Board to clients and their representatives) took place, therefore we omitted the word %u2018local%u2019. Consensus Processes (CP)were mostly held with direct care staff, the physician, behaviour consultant, and manager responsible for provided daily care and the MDET-coordinator and -expert(s). In a few cases review committees for restrictive measures were also involved. Local opinion leaders (LOL) according to EPOC are explicitly identified as being influential by their colleagues. In long-term care for people with intellectual disabilities, a care team works together on a permanent basis to meet the needs of residents. To organise this collaboration, members of a care team have various functions and roles. For example, a personal caregiver has a leading role in shaping care for a resident and acts as his primary spokesperson. The behavioural consultant responsible for treatment and daily care also has a leading role. To get a care team start implementing MDET these leading roles were used to make first contact. In the process of reducing restrictive measures other care team members, besides the personal caregiver and behaviour consultant, were also identified as Local Opinion Leader. Audit and Feedback (AF) is referred to as %u201cAny summary of clinical performance of health care over a specified period of time. The summary may also have included recommendations for clinical action.%u201d This implementation intervention was used after a period of applying treatment interventions to reduce restrictive measures. The MDET-expert summarised and evaluated performance, and gave feedback with the aim of furthering the process.