Abstract
Background: Vulnerable people abuse is a widespread and serious issue in social and care institutional settings. HAS was mandated by health minister to produce national guidelines. People abused face lots of negative consequences, including higher mortality and morbidity risk. These guidelines provide an overview of issues in the field of vulnerable people abuse, with a focus on prevention. They offer a better understanding of the risk factors in order to develop effective solutions for monitoring and prevention.
Method: The first step consisted of a scoping phase to identify major questions, barriers and levers, and key issues through a review of literature, consultation of both experts and stakeholders (patient associations). The second step included a multidisciplinary workgroup including a third of patient representatives to write proposals. Guidelines and implementation tools have been developed after a testing phase. The last step consisted of an experts and stakeholders review.
Results: The HAS has published national guidelines for the care and social care sectors with 4 implementation tools, and 3 patients leaflets. Guidelines propose 7 priorities to prevent abuse within institutions :
- governance and management involvement.
- patient have to be informed of their rights and have to be considered as actor in their care;
- three levels of risk factors analysis are required : 1. Those related to organization. 2 those related to teamwork, 3 those related to patient vulnerability (factors such as non adapted organization or management, neglect, mental health problem, or dependence on others for activity of daily living assistance make those people vulnerable to mistreatment);
- individualized plan has to be regularly reviewed involving patients;
- patient relatives have to be a strong partnership with professionals;
- respectful professional attitudes and reporting culture are to be reinforced;
- collaboration between patient representative and professionals plays an essential role in prevention.
Four implementation tools are concerned with the identification of abuse situation, professional attitudes of well-being, analysis of risk factors and a visual synthesis.
Patient leaflet provides better information about their rights, and encourages engagement during their stay.
Discussion: The many risk factors that contribute to the increase in abuse of vulnerable people underscore the need for assessment to help professionals become aware of abuse situations. It must be accompanied by a preventive actions plan.
Through these guidelines and tools, HAS intends to improve surveillance and monitoring of institutional vulnerable people abuse and deliver a preventive and systemic approach. This combined approach (guidelines, tools for professionals and patients) could be adopted for other practice guidelines.
These guidelines will be integrated into the accreditation of health care organizations and the assessment process of social care institutions. Guidelines and implementation tools enable patients and teams to improve the systemic approach to prevent abuse and promote quality of care.
Globally, this work can also be part of United Nations Decade of healthy ageing (2021-2030).