Using Quality Improvement Methodology to Achieve NICE Compliant Care for People with Intellectual Disabilities Whose Behavior Challenges

BackgroundIn May 2015, NICE published guidelines for people with intellectual disabilities whose behavior challenges (NG11). Eight quality standards were subsequently developed by NICE to help service providers, health and social care practitioners and commissioners implement the necessary recommendations within the new NG11 guidelines.MethodsWe used a Quality Improvement (QI) methodology including process mapping, driver diagrams, and fortnightly QI team meetings. We conducted a baseline audit of the quality standards and used Plan-Do-Study-Act (PDSA) cycles to pilot interventions generated by the team to improve compliance with the standards.ResultsBaseline compliance with the quality standards was low. We identified four priority areas for intervention: annual physical health checks, recording the indication of medication, multidisciplinary case discussion and concurrent psychosocial interventions for those prescribed medications for challenging behavior. Using a PDSA cycle for each intervention, we have demonstrated improved compliance with the NG11 guidelines. Compliance for the recording of indication of medication for all case reviews was previously 0% and now 100%. At least one target case is discussed at each MDT team meeting. Full results for annual health checks are awaited, but intervention has already shown an improvement in the uptake from 40% to 70%. Staff and carers knowledge of psychosocial interventions for people with challenging behavior showed an improvement after training.ConclusionsQuality Improvement methodology was successful in improving adherence to NG11 guidelines. We are currently assessing whether this is leading to reductions in challenging behavior and improvements to people's well-being.