Page 105 - Reduction of coercive measures

Multidisciplinary reduction of coercive measures
To change care practices where coercive measures are employed routinely to address risk behavior, authors have recommended to intervene at multiple interlocking system levels (Huckshorn 2004; Luiselli, 2009; Schreiner et al., 2004; Williams & Grosset, 2011). Stelk (2006) also indicates that the implementation of healthcare innovations is complex and extensive. Behavior and beliefs of employees and standard operating procedures of organizations are likely to persist even after new practices are put in place, because staff and client behavior and expectations will be strongly intertwined. In principle, a multi-component approach needs to affect these interlocking levels to perturb the steady state and cause sustained change.
This study
To test the extent to which a multi-component approach can cause a meaningful change in the number of coercive measures employed, a program was developed and tested aimed at awareness and registration at the organizational level, multidisciplinary consulting at the residential care team level, and multidisciplinary intervention at the resident level. The overall study aim was to test the effect of this program on reducing existing coercive measures. Within the broad definition of coercive measures as ‘every measure that is restrictive in a specific situation’, distinctions were made between physical and mechanical restraint, seclusion, but also restrictions as a consequence of the use of surveillance techniques, and strict rules concerning the use of mobile phones or limitations about when to go leave the unit. Because reasons for specific coercive measures may be time- and context-dependent, we specifically hypothesized program effects on coercive measures aimed at protection of harm and danger as a consequence of challenging behavior or other risks arising from intellectual impairments and related issues. In addition, it was not expected that the application of coercive measures following from organizational policies, for example surveillance techniques, or coercive measures applied to physically support a resident, such as wheelchair tables, would decline.
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