Page 115 - Reduction of coercive measures

Multidisciplinary reduction of coercive measures
Conclusion and discussion
The study shows that a multidisciplinary intervention program affects the reduction of coercive measures at care units of a large health care organization. Program effectiveness did not differ by type of coercive measure. Coercive measures to prevent from danger were most often reduced, while ergonomic supports that restricted motion were reduced least often, irrespective of experimental group. Using a controlled trial design, the current study confirmed the effectiveness (Schreiner, 2004; Williams & Grosset, 2011) of multicomponent approaches to reduce coercive measures which are applied to protect from harm resulting from challenging behavior or other risks related to intellectual disabilities. The present study focused on a broad interpretation of coercive measures and shows that the impact of such a program extends to all forms of coercive measures.
The program involved campaigning to raise awareness of coercive measures and systematically register the use of these measures at the organizational level, augmented in the experimental group with multidisciplinary consulting at the residential care team level and multidisciplinary intervention at the resident level. None of these program elements on its own were assumed sufficient to reduce coercive measures on a large scale (Deveau & McDonell, 2011; Schreiner, 2004; Williams & Grosset, 2011). The effectiveness of the multidisciplinary expert team should therefore be interpreted against the background of these organization-wide efforts. It is known that care practices arise in interaction between resident and support staff members (Stelk, 2006), requiring an integrated effort to reduce coercive measures by altering organizational context, care staff practices, and resident behavior. The importance of making registration of key care practices part of routine care has been previously demonstrated (Deveau & McDonell, 2011; Huckshorn, 2004; Schreiner, 2004; Williams & Grosset, 2011). In the present study, the registration system made it possible for the multidisciplinary expert team to know how many and which coercive measures were applied and reduced. The finding that assignment to the multidisciplinary expert team program accelerated the reduction of coercive measures over and above any effects that the
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