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Rising number of assaults against NHS staff

NICE says physical restraint should be a last resort in handling violent situations

Louise Prime

Thursday, 20 November 2014

Primary care staff should be trained in safe techniques to prevent and handle violent situations, and physical restraint of a patient should be used only as a last resort, says the National Institute of Health and Care Excellence in its latest guidance. NICE’s draft is released at the same time as new figures from NHS Protect show a 13.1% rise in the number of criminal sanctions following physical assaults on NHS staff in England.

NHS Protect revealed today that in 2013/14, a total of 68,683 physical assaults against NHS staff in England were reported, of which 1,731 were in primary care. NICE points out that most assaults are by people being treated for mental health problems or learning disabilities, and is updating its 2005 guideline on the management of violent and aggressive behaviour in people with mental health problems when they’re being cared for in the NHS.

The guidance focuses on how to prevent violent situations from occurring in the first place, and on safely defusing potentially difficult situations and calming people who start to become aggressive – then, lastly, on safe intervention if violence does occur.

NICE recommends that staff in community and primary care teams, as well as staff whose main focus is on mental health, should recognise how each service user's mental health problem might affect their behaviour (for example, their diagnosis, severity of illness, current symptoms and past history of violence or aggression). They should be trained in methods of avoiding violence – including how to recognise the early signs of agitation, irritation, anger and aggression; in de-escalation – for example using techniques for distraction and calming, and ways to encourage relaxation; and in breakaway techniques to help separate them from an aggressor in a safe manner without the use of restraint.

NICE emphasises that, where physical restraint becomes unavoidable, this should not be on the floor and must not be used for more than 15 minutes; the person’s head and neck should be supported and nothing should interfere with their breathing, circulation or ability to communicate. If restraining a person on the floor does become necessary, it should be with their back to the ground – or if prone restraint is unavoidable, this should be for as short a time as possible.

Director of NICE’s Centre for Clinical Practice Professor Mark Baker said: “In the 10 years since the original NICE guidance was published there have been important advances in our knowledge of managing violence and aggression in people with mental health problems …

“Physical restraint should only be used as a last resort, once all other methods of preventing or calming the situation have failed. However, if restraint is the only course of action available, the draft guideline includes clear recommendations on how it should be done to ensure the safety of both staff and the individual.”

Richard Hampton, head of external engagement and services at NHS Protect, added: “No NHS staff should be physically assaulted and we encourage staff who are victims of violence to press charges against assailants.

“Those who work in the NHS have the right to provide care in a safe environment. Employers must do all they can to support staff in preventing incidents and pursuing offenders”.

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