The prevention of deep venous thrombosis in physically restrained patients with schizophrenia

University Psychiatric Center Catholic University, Campus Kortenberg, Kortenberg, Belgium.
International Journal of Clinical Practice (Impact Factor: 2.57). 07/2010; 64(8):1109-15. DOI: 10.1111/j.1742-1241.2010.02380.x
Source: PubMed


Physical restraint and seclusion are associated with several risks. Antipsychotic drug use increases this risk.
To evaluate whether the risk of thromboembolism in physical restraint and seclusion of patients with psychosis, treated with antipsychotic medication, was considered by taking preventive measures.
Anonymous data on all consecutively admitted patients with schizophrenia, treated with antipsychotic medication, between 2002 and 2009, were analysed. Diagnostic information and data about seclusion procedures and medication were collected. Preventive measures of thromboembolism in patients in physical restraint were assessed by reviewing case notes and the medication prescribed at the time of seclusion.
Seclusion of patients with psychosis is common. Out of 679 identified patients, 170 had been secluded (472 events). Physical restraint use was not a rare event (N seclusions with restraint use 296, 62.7%). Pharmacological preventive measures (use of heparine drugs) were taken frequently to prevent deep vein thrombosis (DVT) by physical restraint or isolation. Sixty-five (38.2%) out of 170 secluded patients, including a majority of patients who had been under physical restraint, had been administered anticoagulants at the time of seclusion. No cases of DVT occurred.
Preventive measures were routinely administered in clinical practice and were effective in the prevention of DVT. For a clinical setting, it is important to establish a clear and detailed management plan on seclusion and fixation taken into account in all possible risks of physical restraint.

Download full-text


Available from: Marc De Hert,
76 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in pediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilization in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1,000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies, an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2 to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures. Otherwise, seclusion episodes reduced by 74.7%, including a 32.4% shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behavior, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.
    European Child & Adolescent Psychiatry 02/2011; 20(5):221-30. DOI:10.1007/s00787-011-0160-x · 3.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose – The practice of restraint is controversial as deaths in care or custody have been a consequence of restraint. The purpose of this paper is to clarify research from national and international literature to ascertain any common findings in order to provide guidance for staff on safe and effective restraint techniques where there is no other resort in the management of violent and aggressive individuals. Design/methodology/approach – The researchers undertook a review of the literature on the medical theories relating to restraint-related deaths and an analysis of deaths in custody in the UK for the time period 1 Jan 1999 to 1 Jan 2010. Findings – Findings showed that certain groups are particularly vulnerable to risks while being restrained. There are also biophysiological mechanisms which staff need to be aware of when restraining an aggressive or violent individual. Originality/value – It is evident that those in vulnerable groups when restrained in a prone position, or in a basket hold, for a prolonged period and who are agitated and resistive, are most at risk of death in custody. Consistency in reporting relevant deaths locally and nationally is necessary to facilitate analysis of key information and prevent deaths in custody in the future. Staff training and awareness are also key factors.
    10/2011; 2(4-4):178-190. DOI:10.1108/20420921111207873
  • [Show abstract] [Hide abstract]
    ABSTRACT: The main aim of this guidance of the European Psychiatric Association is to provide evidence-based recommendations on the quality of mental health services in Europe. The recommendations were derived from a systematic search of the best available evidence in the scientific literature, supplemented by information from documents retrieved upon reviewing the identified articles. While most recommendations could be based on empirical studies (although of varying quality), some had to be based on expert opinion alone, but were deemed necessary as well. Another limitation was that the wide variety of service models and service traditions for the mentally ill worldwide often made generalisations difficult. In spite of these limitations, we arrived at 30 recommendations covering structure, process and outcome quality both on a generic and a setting-specific level. Operationalisations for each recommendation with measures to be considered as denominators and numerators are given as well to suggest quality indicators for future benchmarking across European countries. Further pan-European research will need to show whether the implementation of this guidance will lead to improved quality of mental healthcare, and may help to develop useful country-specific cutoffs for the suggested quality indicators.
    European Psychiatry 02/2012; 27(2):87-113. DOI:10.1016/j.eurpsy.2011.12.001 · 3.44 Impact Factor
Show more