6114 A call to avoid restraint in CYP mental health crises: UCLH audit in a wider context

Objectives Convey the findings of a clinical audit regarding the NICE guidelines for self-harm at University College London Hospital (UCLH). Findings have a wider impact on care of children and young people (CYP) across the UK, particularly in instances of physical and chemical restraint Implications discussed in the context of recently published national data¹ Methods 1) Familiarisation of NICE guidelines Defining self-harm Guidance applicable to UCLH: 90/125 recommendations Themes to develop search terms for patient records in steps 2 and 3 2) Systematically reviewed North Central London crisis and referral data from May 2022 to May 2023 Search terms: self-harm/overdose/superficial injury Calculated sample size: 572 individuals Figure 1 displays all presentations of self-harm from May 2022 to May 2023 3) Used associated MRN numbers to identify samples in EPIC Search terms (relevant to each sub-category): stigma/aftercare/safety planning Extracting information from consultation/assessment notes Revisited each recommendation and provided relevant supporting evidence Results Graph 2 displays 87(97%) recommendations met, 1(1%) partially met, and 2(2%) not met. Despite high compliance to the NICE guidelines, we were intrigued by the recommendations not met. With the May 2023 publication of an interim report,¹ we took a further look at the use of restraint (physical and chemical). 3 patients whereby restraint was used on multiple occasions during ED/inpatient stays Patient A was male, age 14, and had ASD and LD diagnosis Patient B was female, age 12, had cerebral palsy, LD and suspected ASD Patient C was male, age 16, and had ASD diagnosis Conclusion The use of restraint within UCLH is a lesson not just for our trust, but for all trusts nationally. A new report has revealed that the use of restraint within paediatric wards is traumatising for both patients and witnesses.¹ General paediatric wards that treat mental health problems do not have separate rooms or sections from patients being treated for general health problems.² Many are separated by a curtain within a larger space, giving little privacy. Using restraint has been found to be traumatising for patients following this experience.¹ This is also evident at UCLH, where restraint was used on a patient (C) with ASD, where it should not have been. As in this instance, caretakers report feeling unsafe in this type of ward environment.¹ Thus, trusts should aim to promote the importance of using and improving de-escalation techniques in order to reduce/prevent the use of restraint in the future. References Interim report – Keeping children and young people with mental health needs safe: the design of the paediatric ward, Healthcare Safety Investigation Branch, May 2023. Supporting children and young people (CYP) with mental health needs in acute paediatric settings. A framework for systems, NHS, November 2022.