The mental health safety improvement programme: a national quality improvement collaborative to reduce restrictive practice in England

Abstract

In 2018, 38 mental health inpatient wards belonging to NHS trusts across England took part in the national reducing restrictive practice collaborative project, which aimed to reduce the use of rapid tranquillisation, restraint and seclusion of patients by 33%. Teams were supported to use quality improvement tools by skilled coaches as part of a national collaborative learning system. At the end of the programme, the overall use of restrictive practice had reduced by 15%. Of the teams that achieved improvements, the average reduction in restrictive practice was 61%. Across the collaborative there were improvements in the mean monthly use of restraints and rapid tranquillisation, and in the total use of all three measures of restrictive practice combined. Support from quality improvement coaches allowed ideas to be tested across the collaborative, enabling the creation of a theory of change for reducing restrictive practice based on areas with a high degree of belief to inform future improvement work in this area.