DUNDRUM Restriction-Intrusion of Liberty Ladders (DRILL) Audit Toolkit

Abstract

This series of rating 'ladders' is intended to allow a quantitative and qualitative analysis of the use of restrictive and intrusive interventions as part of the therapeutic management of violence and aggression in psychiatric hospital settings. This is an evolving handbook. The ladders are currently organised to facilitate a behavioural analysis. Context, antecedents, behaviour, interventions, consequences are conceptualised as a series of events organised in temporal sequence so that causes, interactions and effects can be considered. The complexity of analysis possible is limited by the statistical power of the numbers of cases and events available. The use of the DUNDRUM-1 triage security scale may enable some benchmarking of patient groups according to their average need for therapeutic security for comparative purposes, when combined with measures of risk such as the DASA and HCR-20, while the quantitative relational security in a given unit provides an essential further aspect of context.