Page 157 - Demo

Implementing MDET: Evaluating adaptations and effectiveness1556of coercive measures were correctly recorded (Schippers et al., 2018). In cases of emergency situations that place clients or others at immediate risk, involuntary care measures can be applied even though these are not yet recorded. Afterwards care staff report this within 48 hours as %u2018unforeseen care%u2019, with a maximum validity period of two weeks. Because these emergency situations often involve incidents with clients, care staff also report these incidents in the digital reporting system. This incident reporting system contains a semi-structured form including questions about when and where the incident occurred, who was involved, what type of incident it was, whether people were left injured and how the incident was followed up (Schuengel et al., 2020).For the purpose of this study, all forms of recordings of involuntary care and unforeseen care were combined, under the term involuntary care. A previous study found adequate reliability agreement (Cohen%u2019s kappa > .50) between care staff and trained observers concerning recordings for 25 for the most common forms of involuntary care (out of 57 forms) (Schippers et al., 2018). Each recording includes the starting date and the form of the measure, such as restriction on freedom of movement, administration of medication, and restriction of visits or use of the telephone (Bakkum et al., 2023). In consultation with MDET coordinators the following incident reports were included in this study, because of their potential link with involuntary care measures: aggression (including verbal and physical aggression, violence and sexual transgressions), falling, running away or being missing (whereabouts unknown), getting burned, fire setting, incidents involving pricking, cutting, biting and spitting, intake of harmful substances, suicide attempts, and incidents involving bumping, pinching, and colliding. Incident reports concerning medication errors were excluded. Weekly counts of recordings of involuntary care and incidents reports for the care homes in both the implementation and CAU condition were extracted by data managers of the four organisations. They provided anonymised Excel tables for each care home in both conditions containing information about the start dates of MDET, the number of clients receiving care, and weekly recordings of involuntary care and incidents reports.