Document Title Blanket Restrictions...Northumberland, Tyne and Wear NHS Foundation Trust Appendix-1-NTW(C)59 Blanket Restrictions V01.1-Nov 19 Document Title Blanket Restrictions Reference

Northumberland, Tyne and Wear NHS Foundation Trust Appendix-1-NTW(C)59 Blanket Restrictions V01.1-Nov 19

Document Title Blanket Restrictions

Reference Number NTW(C)59

Lead Officer Russell Patton

Group Director and Deputy Chief Operating Officer

Author(s) (name and designation)

Antony Gray Head of Safety, Security and Resilience

Russell Patton Group Director and Deputy Chief Operating Officer

Ron Weddle Deputy Director Positive and Safe Care

Ratified by Business Delivery Group

Date ratified November 2018

Implementation Date January 2019

Date of full implementation

January 2019

Review Date November 2021

Version number V01.1

Review and Amendment

Log

Version Type of change

Date Description of change

V01 New Nov 18

V01.1 Update Nov 19 Governance Changes

This policy supersedes:

Document Number Title

NTW(C)59-V01 Blanket Restrictions

NTW(C)59

Northumberland, Tyne and Wear NHS Foundation Trust NTW(C)59 Blanket Restrictions –-V01.1-Nov 19

NTW(C) 59 Blanket Restrictions

Section Contents Page No.

01 Blanket Restrictions Flowchart 0

1 Introduction 1

2 Purpose 1

3 Duties, Accountability and Responsibilities 2

4 Definition of Terms 3

5 Procedure 3

6 Identification and Documentation of Blanket Restrictions

6

7 Issues specifically relating to Secure Services 7

8 Governance Arrangements 8

9 Communication 8

10 Identification of Stakeholders 8

11 Training 8

12 Implementation 9

13 Equality and Diversity 9

14 Fair Blame 9

15 Patient Information Leaflets 9

16 Fraud and Corruption 9

17 Monitoring 9

18 Associated documents 9

19 References 9

Standard Appendices – attached to policy

A Equality Analysis Screening Toolkit 10

B Training Checklist and Training Needs Analysis 12

C Audit Monitoring Tool 14

D Policy Notification Record Sheet - click here

Appendices – attached to policy

Appendix No: Description

Appendix 1 Management and Governance Escalation Flowchart

Appendix 2 Identification and Justification form

https://www.cntw.nhs.uk/about/policies/appendix-d-policy-notification-record-sheet/

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0 Northumberland, Tyne and Wear NHS Foundation Trust NTW(C)59 Blanket Restrictions – V01.1-Nov 19

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1 Introduction

This policy has been created to allow Northumberland, Tyne and Wear NHS Foundation Trust to have a transparent and open view of the Blanket Restrictions in place, and to allow an effective review process for monitoring compliance.

2 Purpose 2.1 Blanket restrictions are sometimes needed in order to ensure safety within

service areas operated by Northumberland, Tyne & Wear NHS Foundation Trust (NTW). However, such restrictions have the potential to have huge impacts on people’s lives and can potentially violate Article 8 of the European Convention on Human Rights (ECHR), which requires public authorities to respect person’s right to a private life. This policy is in place to ensure that NTW fulfils its legal and good practice obligations in relation to blanket restrictions, with the aim of reducing them to a minimum.

This is a Trust wide policy and applies to all areas in which the Trust supports people in wards and community settings.

2.2 Ch. 1.6 Mental Health Act Code of Practice (MHA CoP) states;

Restrictions that apply to all patients in a particular setting (blanket or global restrictions) should be avoided. There may be settings where there will be restrictions on all patients that are necessary for their safety or for that of others. Any such restrictions should have a clear justification for the particular hospital, group or ward to which they apply. Blanket restrictions should never be for the convenience of the provider. Any such restrictions should be agreed by hospital managers, in this context it means the Directors of the Board, be documented with the reasons for such restrictions clearly described and subject to governance procedures that exist in the relevant organisation.

2.3 In addition, Chapter 8 of (MHA CoP) is concerned with privacy, safety and

dignity, including the duty of public authorities to respect patients’ rights to a private life under Article 8 of the European Convention of Human Rights (ECHR). It pays particular attention to the practice of implementing blanket restrictions.

2.4 No form of blanket restriction should be implemented unless expressly

authorised by the Hospital Managers on the basis of the organisations policy and subject to local accountability and governance arrangements (Ch 8.9 MHA CoP)

2.5 Blanket restrictions which have been approved by NTW’s Board will be

appended to this policy; any such appended restriction will be deemed to meet the MHA CoP requirement for being expressly authorised by the Hospital Managers on the basis of Trust policy.

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This policy describes how the Trust will meet the requirements of the MHA CoP with regard to blanket restrictions, when these are unavoidable.

2.6 The purpose of the policy is to ensure that the Trust fulfils its legal and good

practice obligations in relation to blanket restrictions, with the aim of reducing them to a minimum. The policy aims to support a culture where services are open and honest about the blanket restrictions that they employ and to ensure a proper process of consideration and documentation is applied to each such restriction.

3 Duties, Accountability and Responsibilities 3.1 The Chief Executive

The Chief Executive is responsible for ensuring that the systems on which the Board relies to govern the organisation are effective. The annual governance statement is signed indicating that systems of governance, including risk management are properly controlled. The Trust’s Chief Executive through the Executive Director of Nursing and Chief Operating Officer is responsible for ensuring the policy is updated and available to all staff.

3.2 Board of Directors

NTW Board of Directors is responsible to approving and monitoring blanket restrictions for use in specific service areas.

3.3 Locality Group Directors

The Group Directors are responsible for ensuring that all Managers in their areas are aware of the policy and support its implementation.

3.4 Associate Directors

Associate Directors are responsible for ensuring that this policy is implemented within their specific clinical business unit, and to ensure that blanket restrictions are suitable recorded and reported on.

3.5 Clinical Managers/Ward Managers/Team/Departments Managers

They are responsible for ensuring that the policy is fully implemented within the ward environment/the team/the department that they manage. They must ensure that the policy is readily available to all staff at all times. Managers must ensure that the recording and auditing is completed in line with this policy. Managers must respond appropriately to any concerns regarding the implementation of this policy within their service area.

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3.6 Local Security Management Specialists / Safeguarding Leads

These subject experts are available to support clinical teams around operational issues that present with the implementation of this policy and around incident reporting and should be contacted for advice in the Safer Care Team.

3.7 All staff

All staff members are responsible for ensuring that their practice is safe and is provided in accordance with current legislative frameworks. All staff members are required to ensure they (and anyone they line manage) abide by NTW requirements as set out in this policy.

4 Definitions 4.1 Blanket Restrictions

The term blanket restrictions refers to rules or policies that restrict a patient’s liberty and other rights, which are routinely applied to all patients, or to classes of patients, or within a service, without individual risk assessments to justify their application (Ch. 8.5, MHA CoP). Blanket restrictions as defined in MHA CoP include restrictions concerning: access to the outside world, access to the internet, access to (or banning) mobile phones and chargers, incoming or outgoing mail, visiting hours, access to money or the ability to make personal purchases, or taking part in preferred activities. Such practices have no basis in national guidance or best practice; they promote neither independence nor recovery, and may breach a patient’s human rights (Ch 8.7 MHA CoP) This definition is to be applied to all service areas within the Trust, not just hospital wards.

5 Procedure 5.1 Principles of Practice

The specific processes that should be followed are set out below, and (in summary) in the flowchart Appendix 1 of this policy. These are based on the following principles and legal frameworks. General principles

Blanket restrictions should be avoided unless they can be justified as necessary and proportionate responses to risks identified for particular individuals. The impact of a blanket restriction on each service user should be considered and documented in the patients’ record. (Ch 8.5 MHA CoP)

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Sometimes restrictions are needed for risk management in relation to one or more service users, resulting in blanket restrictions which unnecessarily impact on others who do not need such restrictions. For the other individuals affected, consideration should be given to how they are affected by these restriction, whether these effects could be mitigated and the legal frameworks that are being used (see below). It may be appropriate to consider whether it is still appropriate for these individuals to share an environment.

Restrictions should never be introduced or applied in order to punish or humiliate but only ever as a proportionate and measured response to an identified and documented risk; they should be applied for no longer than can be shown to be necessary. (Ch 8.6 MHA CoP)

5.2 Legal Frameworks

For informal patients, their consent is required for their care and treatment i.e. restrictions blanket or otherwise would be authorised by a patients capacitous consent.

For detained patients the legal authority to impose restrictions, blanket or otherwise would come from either the patient themselves or the Mental Health Act 1983 (MHA).

Where a patient lacks capacity in respect of understanding the restrictions, blanket or otherwise are necessary due to their mental disorder the legal authority would come from the MHA. For restrictions not related to mental disorder the legal authority would come from the Mental Capacity Act 2005 (MCA) in Best Interest.

If blanket restrictions amount to a deprivation of liberty as defined by the ‘acid test’ set in the Cheshire West case (i.e. subject to continuous supervision and control and not free to leave) those subject to them must have their deprivation of liberty authorised by detention under the MHA (if they are in hospital), or by Deprivation of Liberty Safeguards (DoLS) under the MCA (if they are in hospital and eligible for DoLS or a registered care home) or an order made by the Court of Protection.

5.3 Process – prohibited items and searching

There is an agreed Trust wide list of items not allowed in care areas (lighters/matches and fire hazard materials; illicit drugs/substances; alcohol; medication from home; weapons; sharp instruments; rope; pornographic materials; violent/racist materials). By local agreement, other items may be added to this list.

5.4 If there is cause to search a detained patient or their belongings or surroundings, the search must be done in accordance with Trust Search Policy – (NTW(C)11) and Ch 8.29 – 8.46 MHA CoP. Consult the policy with

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regard to informal/voluntary patients. Authority to search much be sought; those permitted to authorise a search are included in the NTW Search Policy.

5.5 Any private property that is legal to possess, but is handed over by the patient for safe keeping, must be stored and the patient allowed to have access to it in accordance with (Ch 8.24 MHA CoP) and Trust Policy – Patient Valuable Property – SFI – PGN – 16 -03.

5.6 Please refer to the relevant policies for the management of property that is illegal to possess, such as illicit substances, (substance misuse and harmful substances on inpatient wards policy) and offensive weapons (Security policy). Seek advice from the Local Security Management Specialist / Safeguarding Leads with regard to other potentially illegal items, and report any weapons / illicit substance related incidents.

5.7 Do not destroy or dispose of any property without specific permission from a relevant Associate Director / Clinical Manager or in absence the Group Director of the Locality Care Group..

5.8 Exceptions permitted by the CQC in its ‘Brief Guide for Inspectors’

5.9 The CQC Brief Guide for Inspection Teams – The Use of Blanket Restrictions in Mental Health Wards - Link to CQC Guide states that banning of the following ‘prohibited’ or ‘contraband’ items should not be challenged as a Blanket Restriction. This is not an exhaustive list.

Alcohol and drugs or substances not prescribed

Items used as weapons (firearms, real or replica, knives, other sharps, bats)

Fire hazard items (flammable liquids, matches, incense)

Pornographic material

Material that incites violence or racial/cultural, religious/gender hatred

Clingfilm, foil, chewing gum, blu-tack, plastic bags, rope, metal clothes hangers

Laser pens

Animals

Equipment that can record moving or still images with the exception of mobile phones (i.e. Camera, web cameras).

Smoke-free policies are deemed to be justifiable blanket restrictions

5.10 Additional Permitted Exceptions – Secure Settings

Mobile phones

Computers, Tablets, Games Devices with hard drives or sharing capabilities

Items with voice recording capabilities

Other items with enabled WiFi/Internet capabilities

Items considered an escape aid

https://www.cqc.org.uk/sites/default/files/20180502_900767_briefguide-blanket_restrictions_Mental_Health_Wards_v2.pdf

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Restrictions on access to money will be part of the security fabric of the ward

Restrictions on take away food may be in place to ensure therapeutic activity of the ward is not undermined

5.11 The CQC Brief Guide also refers to searching:

General Acute Wards: Random or routine searching permitted if there is specific cause

Psychiatric Intensive Care Units (PICU): Random or routine searching backed by policy which includes clear rationale on the purpose of any search

Low Secure Wards: Random searching likely, routine searching at times in response to specific issues

6 Identification and Documentation of Blanket Restrictions

(Flowchart included at Appendix 1 Blanket Restriction/Management Governance Escalation Process)

6.1 The impact on each patient of any blanket restriction must be recorded in their own clinical record.

6.2 Each in-patient ward will have a register detailing any Trust wide blanket restrictions in place in that location and will be available on the Trust Intranet – under the Blanket Restrictions section of Safer Care. The patient will be informed of these restrictions as part of the process of explaining their rights under the NHS and a record made that they have received this information.

6.3 Any Trust wide blanket restrictions will have an underpinning rationale and will have been considered and approved by the Trust Board.

6.4 Each area will maintain a blanket restrictions register of any blanket

restrictions over and above the Trust wide blanket restrictions available to patients and carers.

6.5 Blanket restrictions approved by NTW’s Board will be appended to the policy.

6.6 Each Clinical Management Team Meeting (CMT) must review its practices, for existing blanket restrictions and any discontinuation plans on a regular basis at the appropriate meeting (at least 6 monthly) in order to identify and minimise the use of blanket restrictions. A record of these reviews is to be maintained in the minutes.

6.7 In the event that a practice is newly identified as a blanket restriction, an identification and justification form must be completed and submitted to NTW’s Board for approval. Form available at Appendix 2

6.8 If it is not immediately necessary to apply the restriction in a blanket fashion, ensure that it is only applied to the patient/s whose presentation warrants the restriction.

https://weblive.ntw.nhs.uk/saferCare/?index&m=view_cards&id=19

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6.9 If it is immediately necessary for risk management purposes to impose the

restriction in a blanket fashion and this cannot be avoided after discussion with the Clinical Manager, this must be authorised by the Clinical Manager or the person formally deputising for the Clinical Manager.

6.10 The imposition of an immediately necessary blanket restriction must be reported by the completion of a web based incident form, highlighting the blanket restriction category.

6.11 All patients should be informed that the restriction is in place and why as far as possible, having due regard to any issue of confidentiality. A record of this conversation should be included in the patient’s clinical record.

6.12 The identification and justification form must be provided to the Associate Director or his/her deputy as soon as is practicable.

6.13 If this continues beyond a month this should be escalated to the appropriate

Group Director of the Locality Care Group.

6.14 If the need for the blanket restriction continues, it must go before Business Delivery Group - Safety in line with Quarterly reporting cycle.

7. Issues specifically relating to secure services (Ch 8.8 MHA CoP) 7.1 Within secure service settings some restrictions may form part of a broader

package of physical, procedural and relational security measures associated with an individual’s identified need for enhanced security in order to manage high levels of risk to other patients, staff and members of the public.

7.2 The individual’s need for such security measures should be justified to meet the admission criteria for any secure service. In any event, the application of security measures should be based on the needs of and identified risks for the individual service users, and impose the least restriction possible.

7.3 Where individual service users in secure services are assessed as not requiring certain security measures, consideration should be given to relaxing their application, where this will not compromise the overall security of the service. Where this is not possible, consideration should also be given as to whether the service user should more appropriately be managed in a service that operates under conditions of lesser security.

7.4 Each of these areas has specific criteria for admission and protocols for discharge which conform to the requirements of the MHA CoP in respect of the need for the care of an individual patient to be delivered in conditions of enhance security.

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8 Governance arrangements (See Appendix 1)

8.1 In addition to the local arrangements described above, each CBU should put in place processes for identifying and appropriately responding to blanket restrictions within its service areas.

8.2 Any blanket restriction identified by the CQC during inspections or monitoring visits will be addressed by the Provider Action Statement (PAS) and associated action plans.

8.3 CQC compliance action plans are monitored and overseen by the Trusts CQC Quality Compliance Group.

8.4 Mental Health Act Reviewer Provider Action Plans are considered at the Mental Health Legislation Steering Group

9. Communication Details will be available on the Trusts intranet site

The policy will be made available to all staff via the Intranet and Trust website. A communication will be issued to all staff via the Communication Department immediately following publication.

10. Identification of Stakeholders

North Locality Care Group

Central Locality Care Group

South Locality Care Group

North Cumbria Locality Care Group

Corporate Decision Team

Business Delivery Group

Safer Care Group

Communications, Finance, IM&T

Commissioning and Quality Assurance

Workforce and Organisational Development

NTW Solutions

Local Negotiating Committee

Medical Directorate

Staff Side

Internal Audit

11 Training

Training will be provided in line with this policy implementation, and co-ordinated and recorded by NTW Academy, this information on compliance will be available via dashboards.

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12 Implementation

The policy will be implemented with a robust communication strategy and implementation will be overseen by BDG.

13 Equality and Diversity

In conjunction with the Trust’s Equality and Diversity Officer this policy has undergone an Equality and Diversity Impact Assessment which has taken into account all human rights in relation to disability, ethnicity, age and gender. The Trust undertakes to improve the working experience of staff and to ensure everyone is treated in a fair and consistent manner. (See Appendix A)

14 Fair Blame

The Trust is committed to developing an open learning culture. It has endorsed the view that, wherever possible, disciplinary action will not be taken against members of staff who report near misses and adverse incidents, although there may be clearly defined occasions where disciplinary action will be taken.

15 Patient Information Leaflets

Any information given to patients needs to be in an accessible format, accurate and ‘branded’ correctly. Northumberland, Tyne and Wear NHS Foundation Trust (the Trust) follows the process around production of this information as outline in the Trust’s, NTW(O)03 – Accessible Information for Patients, Carers and Public Policy.

Patient Information leaflets will be reviewed every 3 years with the exception of those documents which are reviewed on an annual basis. However, should there be any changes in legislation or practice; all documents will be reviewed immediately irrespective of review date.

16 Fraud, Bribery and Corruption

In accordance with the Trust’s NTW(O)23 – Fraud, Bribery and Corruption Policy, all suspected cases of fraud and corruption should be reported immediately to the Trust’s Local Counter Fraud Specialist or to the Executive Director of Finance.

17 Monitoring

Monitoring of this policy will be in line with the key performance indicators identified in Appendix C

18 Associated documents Policy on Procedural Documents – NTW (O)01

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Alcohol and Illicit Substance Misuse Policy – NTW (O)12 Security Management Policy – NTW (O)21 & Practice Guidance Notes Search Policy – NTW (C) 11 Care Programme Approach – Policy NTW(C) 20 and associate Practice Guidance Notes Children and Young Peoples (CYPS) Care Co-ordination / Care Programme Approach Policy – NTW (C) 48 Patient Valuable / Property – SFI – PGN-16-03 Safeguarding Adults and Childrens Policy – NTW (C) 24 and NTW (C) 04

19 References

Care Quality Commission – Brief Guide – Blanket Restriction on In-Patient Wards Mental Health Act 1983 (MHA) and MHA Code of Practice (2015) Mental Capacity Act 2005 (MCA) and MCA Code of Practice Mental Capacity Act Deprivation of Liberty Safeguards (DoLS) and DoLS Code of Practice Cheshire West and Chester Council v P[2014] UKSC 19, [2014] AC 896

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11 Northumberland, Tyne and Wear NHS Foundation Trust NTW(C)59 Blanket Restrictions –-V01-Nov 18

Appendix A

Equality Analysis Screening Toolkit

Names of Individuals involved in Review

Date of Initial Screening

Review Date Service Area / Directorate

Tony Gray November 2018 November 2021 Trust-wide

Policy to be analysed Is this policy new or existing?

Blanket Restrictions – NTW(C)59 New

What are the intended outcomes of this work? Include outline of objectives and function aims

This policy is intended to provide a governance system for reporting and recording of blanket restrictions within the Trust.

Who will be affected? e.g. staff, service users, carers, wider public etc

staff, service users.

Protected Characteristics under the Equality Act 2010. The following characteristics have protection under the Act and therefore require further analysis of the potential impact that the policy may have upon them

Disability Not Applicable

Sex Not Applicable

Race Not Applicable

Age Not Applicable

Gender reassignment

(including transgender)

Not Applicable

Sexual orientation. Not Applicable

Religion or belief Not Applicable

Marriage and Civil Partnership

Not Applicable

Pregnancy and maternity

Not Applicable

Carers Not Applicable

Other identified groups Not Applicable

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How have you engaged stakeholders in gathering evidence or testing the evidence available?

Through standard Policy Process Procedures

How have you engaged stakeholders in testing the policy or programme proposals?


For each engagement activity, please state who was involved, how and when they were engaged, and the key outputs:


Summary of Analysis Considering the evidence and engagement activity you listed above, please summarise the impact of your work. Consider whether the evidence shows potential for differential impact, if so state whether adverse or positive and for which groups. How you will mitigate any negative impacts. How you will include certain protected groups in services or expand their participation in public life.

Not applicable

Now consider and detail below how the proposals impact on elimination of discrimination, harassment and victimisation, advance the equality of opportunity and promote good relations between groups. Where there is evidence, address each protected characteristic

Eliminate discrimination, harassment and victimisation

Not applicable

Advance equality of opportunity Not applicable

Promote good relations between groups Not applicable

What is the overall impact?

Not applicable

Addressing the impact on equalities Not applicable

From the outcome of this Screening, have negative impacts been identified for any protected characteristics as defined by the Equality Act 2010? No

If yes, has a Full Impact Assessment been recommended? If not, why not?

Manager’s signature: Tony Gray Date: November 2018

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Appendix B Communication and Training Check list for policies

Key Questions for the accountable committees designing, reviewing or agreeing a

new Trust policy

Is this a new policy with new training requirements or a change to an existing policy?

New Policy

If it is a change to an existing policy are there changes to the existing model of training delivery? If yes specify below.

N/A

Are the awareness/training needs required to deliver the changes by law, national or local standards or best practice?

Please give specific evidence that identifies the training need, e.g. National Guidance, CQC,NHS Resolutions etc.

Please identify the risks if training does not occur.

Identified as part of CQC Blanket Restrictions Action Plan

Please specify which staff groups need to undertake this awareness/training. Please be specific. It may well be the case that certain groups will require different levels e.g. staff group A requires awareness and staff group B requires training.

Initial training for inpatient staff with staggered roll out to community teams

Is there a staff group that should be prioritised for this training / awareness?

Inpatient Registered and Non-Registered Nurses

Please outline how the training will be delivered. Include who will deliver it and by what method. The following may be useful to consider: Team brief/e bulletin of summary Management cascade Newsletter/leaflets/payslip attachment Focus groups for those concerned Local Induction Training Awareness sessions for those affected by the new policy Local demonstrations of techniques/equipment with reference documentation Staff Handbook Summary for easy reference Taught Session E Learning

Mixed model of delivery with limited central delivery via classroom / skype and focused delivery locally within teams. Session will also be incorporated into centrally delivered Mental Health Legislation Training.

Please identify a link person who will liaise with the training department to arrange details for the Trust Training Prospectus, Administration needs etc.

Policy Authors

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Appendix B – continued

Training Needs Analysis

Staff/Professional Group Type of training

Duration of

Training

Frequency of Training

All clinical inpatient staff Local face to face

No more than 1 hour

3 yearly

All remaining clinical staff Local face to face

No more than 1 hour

3 yearly

Should any advice be required, please contact: - 0191 245 6777 (Option 1)

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Appendix C Monitoring Tool

Statement

The Trust is working towards effective clinical governance and governance systems. To demonstrate effective care delivery and compliance, policy authors are required to include how monitoring of this policy is linked to auditable standards/key performance indicators will be undertaken using this framework.

Blanket Restrictions Policy – NTW (C) 59- Monitoring Framework

Auditable Standard/Key Performance Indicators

Frequency/Method/Person Responsible

Where results and any Associate Action plan will be reported to implemented and monitored; (this will usually be via the relevant Governance Group).

1. Baseline of Blanket Restrictions in place Trust-wide

At implementation of Policy / Policy Author / Internal Audit

Once reported through Governance Process.

2. Reporting of potentially restrictive practice as an incident.

As reported on web incident system

As reported / through notification system to Team Managers and Associate Directors.

3. Collective view of activity for all CBU’s

Monthly through Safer Care / Safer Care Intranet / Safer Care Report

CDT-Q

4. Quarterly view of all activity for all CBU’s

Quarterly through Safer Care / Safer Care Intranet / Safer Care Report

CDT-Q BDG – Safety Care Groups – Quality Standards Meetings Quality and Performance Board of Directors

The Author(s) of each policy is required to complete this monitoring template and ensure that these results are taken to the appropriate Quality and Performance Governance Group in line with the frequency set out.

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Appendix 1

16 Northumberland, Tyne and Wear NHS Foundation Trust Appendix 1- Blanket Restrictions. Management and Governance Escalation Process NTW(C)59 Blanket Restrictions –-V01.1-Nov 19

Blanket Restrictions. Management and Governance Escalation Process

Internal Escalation Governance Incident Reporting External Guidance or Findings

Blanket Restriction - Applied or Identified

Trust Board

Add to Ward

Blanket Restriction (BR) Register

Group Quality Standards

Trust

Quality & Performance

Quarterly

Peer Audit

Report to

Clinical Manager

Complete

Online incident Form

Escalate to

Associate Director

Safer Care

Monthly/Quarterly Report

Monthly

Corporate Decision Team Quality (CDT-Q)

Intranet

Update

Approved List

Trust wide Register

Escalate to Group Director

If BR Continues

Business Delivery Group (BDG)

External

Review BR Register at Clinical Business Unit

(CBU)/Clinical Management Team CMT meeting

Corporate Decision Team (CDT)