NICE Evidence Review Highlights Gaps in Evidence Around Managing Aggressive Behaviour in Care Settings
The National Institute for Health and Care Excellence (NICE) is undertaking a major update of its guidance on the prevention and management of aggressive behaviour in health and social care settings.
The work is updating NICE guideline NG10, which covers the short-term management of violence and aggression in mental health, health and community settings. NICE said new evidence and stakeholder views had indicated that the existing recommendations required a full update.
The latest evidence review considers the effectiveness of organisational-level interventions designed to reduce aggressive behaviour, alongside a number of other areas being examined as part of the guideline update.
These include the effectiveness and safety of restrictive practices used for the short-term management of aggressive behaviour, the use of medication during acute episodes, recognising signs of physical health emergencies in people who are being restrained, and the experiences and potential benefits or harms associated with post-incident debriefing and formal reviews.
The breadth of the review is particularly relevant to adult social care providers, where staff can be required to respond to behaviour that may present a risk to the individual, other residents or care workers.
NICE’s work places emphasis on examining the available evidence rather than assuming that commonly used interventions are necessarily effective or without risk.
The evidence reviews form part of an ongoing guideline development process, with NICE considering research evidence alongside the experience and expertise of its multidisciplinary guideline committee.
Minutes from committee meetings show that the group includes professionals and people with relevant experience across health and social care, reflecting the importance of considering aggressive behaviour from both clinical and care perspectives.
Focus on prevention and least-restrictive approaches
For care providers, one of the significant implications of the work is the focus on preventing aggressive behaviour wherever possible rather than relying solely on interventions once an incident has occurred.
The NICE review programme examines organisational approaches as well as interventions used during an acute episode. This reflects the need to consider the wider circumstances in which aggressive behaviour can arise, including the environment, staffing arrangements, communication and the individual’s needs.
Where restrictive interventions are considered necessary, NICE is separately examining their benefits, harms and safety.
This is particularly important because restraint can carry physical and psychological risks, making appropriate assessment, monitoring and staff training critical components of safe practice.
The evidence review examining physical health emergencies during restraint further underlines the need for staff to recognise potentially serious complications when restrictive interventions are used.
Importance of learning after incidents
NICE is also examining what happens after an incident, including the potential role of post-incident debriefing and formal review.
Such processes can provide an opportunity to understand what led to an episode of aggressive behaviour, consider whether the response was appropriate and identify measures that could reduce the likelihood of a similar incident occurring again.
The evidence review specifically considers the benefits and harms of post-incident debriefing for people who have experienced restrictive interventions, alongside wider questions concerning post-incident review.
For residential and nursing care providers, this underlines the importance of viewing incidents not simply as isolated events but as opportunities to examine care planning, communication, environmental factors and staff responses.
Guidance update remains in progress
NICE’s update is still in development, meaning the evidence reviews should not be interpreted as final recommendations for care providers.
The organisation has stressed that recommendations are developed following consideration of the available evidence by the guideline committee.
The updated guideline is expected to provide revised guidance on preventing and managing aggressive behaviour across relevant NHS and social care settings.
For the care sector, the outcome will be closely watched as providers continue to balance the safety of residents and staff with the need to uphold dignity, autonomy and person-centred care.
The latest NICE evidence reviews suggest that the evidence supporting different approaches is complex, with important questions remaining around which interventions are most effective, when restrictive practices may be justified, how risks can be minimised and how people should be supported following an incident.
Until the updated recommendations are formally published, care providers should continue to follow existing applicable NICE guidance, legislation, safeguarding requirements and their own organisational policies and risk-management procedures.
