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Like-minded organisations in pursuit of restraint-free services


Speaker3As part of our ongoing series of guest blogs, here Paul Greenwood, Improvement Advisor at AQuA introduces some of the key aspects of the REsTRAIN YOURSELF programme that he’ll be covering during his workshop at the upcoming Restraint Reduction Conference.

The REsTRAIN YOURSELF project was designed to improve patient safety by avoiding unnecessary harm caused by the use of physical restraint using evidence-based restraint reduction approaches in seven Mental Health Trusts acute in-patient settings in the North West of England.

The programme developed a strategy to implement a US intervention, designed to eliminate restraint and seclusion in a UK NHS setting. It also aimed to investigate the feasibility and effect of its introduction into an acute mental health units that would underpin the design of a larger study to evaluate the effectiveness of the UK-based intervention.

Within the identified acute mental health wards the programme looked to:

Reduce the incidence of harm caused to patients and staff as the result of an 80% reduction in physical restraint by the end of the programme in June 2016;

Roll-out a restraint-reduction organisational approach (6CS-UK) tailored from an evidence-based USA approach; and

Implement a robust approach to improve quality and patient safety.


 1. Identify potential organisational-level barriers and identify and train facilitators to successful implementation of the US ‘Six Core Strategies©‘ (6CS) intervention.

2. Design a UK 6CS© intervention by modifying the US version including a training package and implementation strategies for each component of this for a UK setting.

3. Implement and pilot within seven adult acute admissions wards within seven of the eight North West mental health secondary care providers.

4. Evaluate the acceptability to staff and patients and feasibility of delivery of the intervention in an acute mental health unit to:

Estimate likely recruitment and attrition rates and levels of intervention fidelity for a future trial;

Determine which outcome measures are sensitive to change and obtain preliminary estimates of effectiveness; and

Explore how the component strategies within the intervention are likely to impact on outcome and differences between the wards.

5. Undertake a process and outcome evaluation of the implementation of the intervention.

6. Review and revise the UK approach, training package and implementation plan.

7. Devise and implement a dissemination plan.

Implementing the programme in the acute settings drew on an understanding of complex adaptive theory and human factors theory in order to bring about the changes needed to avoid causing harm to service users through the use of restraint.


  •  Trained trainers in the delivery/support/facilitation of the 6CS-UK
  • Supported roll out of training across participating teams.
  • Introduction and support in use of formal quality improvement methods.
  • Opportunity to participate in a collaborative learning and support network.
  • Evaluation of the impact of the programme.

The programme using quality improvement methodology to measure improvements made in implementing the six core strategies© and completed in June 2016. The evidence has been used to develop a toolkit which will be available for anyone from October 2016, launching on and . The toolkit will cover each element of the Six Core Strategies© alongside quality improvement techniques, case studies and top tips to implement restraint reduction.

The evaluation report will be out in October 2016 showing evidence of a 42% reduction across all wards that implemented the improvements during the six months period.

The workshop is an opportunity for us to present the findings of the programme alongside ward staff from Five Boroughs Partnership NHS Foundation Trust who will talk through the practicalities of implementation, what worked and didn’t work and what still needs to be done.

The workshop will take you through the setting up, implementation and findings including future work in the North West to spread the learning. The current programme run by AQuA includes working with acute adult wards, Psychiatric Intensive Care Units, high, medium and low secure services, CAMHs and older adults mental health wards.