185-1101 / Reducing the use of coercion and mechanical restraint in psychiatry 2012-2015 – A Break Through Series Collaborative at Danish Mental Health Hospitals

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
CFK – Centre for Public Health and Quality Improvement
a centre for research and development in the fields of health care, social services and rehabilitation.
(http://www.cfk.rm.dk/om+os/in+english)CFK is a national project office on behalf of
The Danish Health and Medicine Authority


Quality improvement project
Patient safety culture / Patient safety climate
Surveillance of Patient Safety
GOP Description
Implementation level
Clinical settings
Mental health care hospitals:
34 acute/intensive psychiatric wards/units in Denmark
The five health care regions of Denmark
Reducing the use of mechanical restraints and other types of coercion in psychiatry.
Improving the quality of necessary (non-preventable) coercion.
In-Patients at 34 psychiatric wards
Around 20% of inpatients in psychiatric wars (Mental heath Hospital) are exposed to coercion.
Testing and implementing improvement ideas, for instance:
In-Patients participation in physical training and other meaningful Milieu Training in the ward – and outdoor activities.
Risk Assessment (Broeset Violent Score) to prevent aggression and violence.
De-escalation methods.
Plans and interventions for Patients’ Crises triggers (How can we help you, when you are emotionally agitated?)
Patient-centred care.
Mandatory reviews from clinical experts: analyzing coercion episodes.The process is facilitated by:
National and regional Quality Improvement Collaboratives
Regional Implementation teams
Local QI teams at each Ward
Implementation theory, education (training program – course)
Monthly improvement reports
Feedback systems
Timeframe implementation
2-3 years
Implementation tools available
Rapid PDSA (Plan-Do-Check-Act) Cycles
Model for Improvement
Regional Collaborative Learning Sessions
National Conferences
Regional Implementation Groups
Local Implementation Teams
National Change Packet
Computer-assisted Collaborative Learning (http://vis.dk)
Implementation cost
Financed by the Danish State. Administered by The Danish Health and Medicine Authority.
Method used to measure the results
Mandatory national health registry about coercion (ssi.dk)
+ surveys, reports, interviews, documents
The mid-term evaluation (attached as pdf-file in Danish) shows:

1. The number of coercion incidents tends to be reduced (not statistically significant)
2. The number of patients exposed to coercion tends to be reduced (not statistically significant)
3. The aggregated duration of mechanical restraints tends to be reduced (not statistically significant but very promising).

More than 100 preventive efforts/changes/improvements had been tried and a lot of them implemented in local settings.

Analysis of the results
There is statistical variation and therefore still uncertainty about the final results.
The run charts show a promising development, but no hard evidence can be presented.In March 2015 the project’s final evaluation will be published, and the final report (and results) will be available at: http://tvangipsykiatrien.cfk.rm.dk
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
change in management
change in project participants
lack of time
lack of adequat professional training
the physical environment (no local training facilities, no local outdoor facilities for patients)
Describe the strategies used to overcome the barriers (If needed)
See GOP methodology
Other information
Other information about the GOP that you would like to add (Link or attached document)
read more here: http://tvangipsykiatrien.cfk.rm.dk
(in danish)201408220513093474_158_GOP_Midterm_Evaluation_march2014 in danish.pdf