51 Follow-up of recommendations Some examples of follow-up of the NPM’s recommendations in 2018: Documentation and correct logging of decisions relating to use of coercive measures The NPM discovered under-reporting of the use of coercion in several institutions, and that decisions had been made on inadequate grounds. At certain institutions, administrative decisions had not been sufficiently quality assured by the management. Correct and thorough documentation of the use of coercive measures is essential to ensuring the due process protection of people who are deprived of their liberty. It is also crucial to ensure that internal and external control mechanisms are able to perform their duties. Findings and recommendations During the visit to the emergency psychiatric department at Akershus University Hospital, information emerged indicating that patients were physically restrained without an administrative decision being in place. The NPM recommended that the institution ensure that such decisions were made and recorded in a manner that secures accuracy in the reported uses of coercive measures, and to enable patients to exercise their right to complain. ›› Follow-up The department sought advice and guidance from the Ministry of Health and Care Services as a result of the NPM’s recommendation. The definition of short-term physical restraint of a patient has been specified in accordance with this, and training has been given at the department to ensure that staff are certain of when an administrative decision should be made. ›› Preventing the use of coercive measures Findings and recommendations After visits to both child welfare and mental healthcare institutions, the NPM has expressed concern about several of the institutions not employing systematic measures to prevent use of coercive measures. Preventing the use of coercive measures can be done in many ways and should include staff training and a focus on a good treatment culture, as well as ensuring well-designed premises and better and more available activities. ›› Follow-up A number of institutions have increased their efforts to prevent the use of coercive measures on the basis of the NPM’s recommendations. ›› ››After the visit to the child welfare institution Kvammen, the institution decided to start up weekly staff meetings discussing the use of coercive measures under the Rights Regulations. Work on raising competence in trauma-informed care through the ‘Handlekraft’ programme also became a priority. ››After the visit to Reinsvoll hospital, the NPM recommended that the restraint beds be removed from the segregation areas. Reinsvoll has stated that it has decided to remove all permanently attached mechanical restraints from the beds in the segregation units.