Service development
Service development
Feature
S
ensory interventions can be described as complex interventions that include a wide range of elements , although the ‘ active ingredients ’ can be difficult to specify .
The literature indicates sensory interventions offer a collaborative approach , facilitate personal discovery and empower service users to take ownership and responsibility for their recovery journey .
The DSM-5 defines borderline personality disorder as a long-term pattern of abnormal behaviour , characterised by unstable relationships with other people , unstable sense of self and unstable emotions ( American Psychiatric Association 2013 ).
Many people with borderline personality disorder report feeling overwhelmed with daily life stresses ( Korfine and Hooley 2000 ; Domes et al 2006 ). And studies have indicated that individuals with borderline personality disorder have sensory processing preferences with increased sensory sensitivity and avoidance responses ( Brown et al 2009 ).
Self-harm is a behaviour in which an individual injures themselves as a way of coping with intensely distressing feelings . Head banging is a common form of self-harm , linked to numerous negative outcomes , including significant brain damage . Head banging is clinically associated with personality disorders ( Sansone and Wiederman 2013 ).
Our local problem
Our hospital compliance data indicated there was a high rate of head banging within the personality disorder service . In August 2022 , 12 of the 15 patients engaged in head banging . Using Root Cause Analysis ( RCA ) we were able to understand the problem , the factors involved and the possible causes of the problem .
Head banging negatively impacts progress through the care pathway and treatment outcomes . Documentation indicated that 80 % of the ward population engaged in head banging ; incident records suggested that this behaviour occurred on the ward and that a higher occurrence was seen in communal areas such as the ward balcony .
More incidents were also identified in the evening than during the day . Records also showed how staff responded and attempted verbal deescalation . If these strategies were unsuccessful , hands-on restraint occurred .
A Quality Improvement ( QI ) project was proposed to improve clinical outcomes , with a systematic process to focus on :
• environmental improvements ( physical space and resources )
• developing staff knowledge and skills ( sensory modulation and proactivity )
• patient empowerment with personalised strategies .
Intended improvements
The QI project , which was completed as part of the Level 5 Leadership and Management Diploma , set out to introduce sensory interventions to the service to improve the quality of de-escalation , to support the global priority to reduce and , if possible , eliminate the use of restrictive practices ( DH 2014 ) and to improve the patient experience .
Below : Examples of the sensory resources that were purchased to improve the ward environment
October 2023 OTnews 41