JIM TIGHE West London NHS Trust Jim is a Mental Health Nurse, working in the NHS since 1988 within a variety of clinical settings including Child & Adolescent, Acute, Forensic and Community Care. In addition as a Local Security Management Specialist his focus is on reducing violence and improving safety for those who are cared for, work in and visit the NHS services. He was involved in the working group that published the NHS Protect ‘Meeting Needs and Reducing Distress Guidance’ in 2013. Recently he has been involved with a body camera pilot within West London NHS Trust across a range of their services. www.nahs.org.uk
A pathway to a safer service Positive and Proactive use of technology in clinical settings Jim Tighe - West London NHS Trust
Introduction • West London NHS Trust’s use of body-worn cameras create a safer environment working towards the aims of: • Making people safer • Working together • De-escalating violence • Influencing behavior - behavioral insights (Nudge Theory)? • Brought about these positive changes: • Patients positive feedback • Decrease in violence/aggression • Decrease in time for outcomes of safeguarding investigations (independent witness) Tested during joint operation with MET Police (Operation Duopoly- London Services 2017)
Timeline • 1990’s – saw CCTV introduced in Broadmoor and across West London - service user request. • 2000’s – our Personal Protective Equipment response teams used camcorders – aid review, debrief and achieve best evidence again following lessons from serious incidents • 2014- Body Worn Video introduced to Broadmoor • 2016 - CCTV system in New Medium Secure Unit -communal clinical areas • 2018 – Body worn pilot across 7 inpatient wards acute admissions, PICU, Low, Medium and enhanced Medium Secure • 2019 – Body Worn cameras across acute mental Health Wards and PICU
Sc Scope pe • Objectives for the use of Body Worn Video: • Working together to keep staff and service users safe • Working with service users as part of the project • Accurate and robust evidence for complaint and incident investigations • De-escalating violence • Influencing Behaviour • Facilitate risk assessments and co-production • Learning lessons • Provide a useful tool for staff training
St Streng ngths hs • Safer Environment • Increased service user and carer confidence • Increased staff confidence • Independent witness • Service users involvement and requests for cameras to record • Cameras accepted quickly in all clinical areas, particularly with service users • De-escalation has been seen • Preventative and improved efficiency relating to unproven allegations against staff or service users, length of investigations, safeguarding improvements. • Increased transparency and accountability of staff • Accessibility levels set with a full and transparent audit log
Pilot Project 2018
Ch Challenges/ / Pot otential Ri Risks • Culture and Practice/ Power and Control: - Closed institutions may have issues regarding use and how Camera’s are worn • Passive Resistance • Information Technology support • Equality in clinical areas with service users requesting to record staff activity. Patients saying if you can record me I can record you • Incremental drift- brought in for one reason but used for other reasons over time - how do we set standards • Unintended consequences: - patient says they didn’t want it • Camera used as a threat negative incentive - informal patients - consent and applied consent - private spaces Bedrooms, bathrooms etc
Overview BWV User experience Positive Negative Service Users Can be seen on the staff Not on all the time Subjective when Act as a deterrent only activated by staff Worn for safety of all in the clinical area If I don’t consent then what Useful tool for review and reflection Its only a tool- the staff member Reassurance - when staff use them makes the difference nothing untoward will happen when they are on Prevents incidents Staff Improved confidence to intervene and Remembering to turn them on deescalate an individual Anxious about hearing/seeing Audio recording as well as video themselves on camera Independent witness Uploading issues – delays to see the “A safeguard on my shoulder” footage getting to the cloud Can be seen my ward manager/ team to learn from incidents and debrief
Reflections • Project Management • Needs to be project managed • IT ownership or support to address compatibility, software upgrades & troubleshooting • Staff • Anxiety and remembering to turn camera on • Identifying Champions early for each area and ongoing training Service Users • • Privacy, confidentiality, patient dignity, informed consent? • how long images are kept and who can view them External • • An area of interest and external focus: Media, national organizations and NHS e.g. Guardian society, RCN,
Key findings Acute admission wards Acute admission wards CHANGE Before After Verbal 13 19 +6 Violence 23 37 +14 Restraint 19 22 +3 Injection 10 0 -10 TOTAL 65 78 +13 PICU & Low Secure PICU & Low Secure Wards Before Wards After CHANGE Verbal 30 29 -1 Violence 30 32 +2 Restraint 11 8 -3 Injection 3 4 +1 TOTAL 74 73 -1 Women’s Forensic Women’s Forensic Before After CHANGE Verbal 51 27 -24 Violence 11 13 +2 Restraint 14 17 +3 Injection 1 0 -1 TOTAL 77 57 -20
Pilot Project 2018 Findings • Overall 21% reduction in Verbal abuse 22% increase in violence, 6% increase in restraint and 71.5% reduction in Rapid Tranq with restraint • Women’s Forensic Service 47% reduction in Verbal Abuse from 51 to 27 incidents • Acute admission wards 100% change in highest level of seriousness - Rapid Tranq with restraint from 10 to 0
Key Learning • Human Factors • Human Rights - Privacy and Dignity • Need right resources for it to work • Service User and Staff involvement throughout • Know your limits and capability at the outset Key Points • Must have a clear purpose from the beginning “safety for service users, staff and visitors • Limited empirical research into healthcare use and evaluations carried out on BWV • It is a tool it can help but won’t in itself make a change.
Considerations • Must have a clear purpose from the beginning “safety for service users, staff and visitors” • Clear statement of purpose, set parameters, access and management of the system • Choice of systems - must have strong governance and control measures in place. Is the data secure? • Variations of systems and products on the market. What does the right product look like? • Where the camera is worn variations on the market some more obtrusive than others and people are different. Lens pick up variations may restrict areas the camera’s can be worn on the body. • How do you prevent misuse or unintended consequences creep? • How do we assist clinicians answer difficult questions ?
Questions • Demo- H:\CCTV\BODY WORN CAMERAS\Presentaitons\NAHS Nov 2019\Demo clip.mp4 • Any Questions?
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