Elements of successful restraint and seclusion reduction programs and their application in a large, urban, state psychiatric hospital.
ABSTRACT In recent years, there has been a strong desire on the part of inpatient psychiatric programs to reduce the use of seclusion and mechanical restraint. There is a consensus among those who have published descriptions of successfully implemented restraint and seclusion reduction programs that the essential elements of such programs are high level administrative endorsement, participation by recipients of mental health services, culture change, training, data analysis, and individualized treatment. This article describes these elements and their application in a successful restraint reduction program at Creedmoor Psychiatric Center, a large, urban, state-operated psychiatric hospital that reduced its combined restraint and seclusion rate by 67% over a period of 2 years.
SourceAvailable from: Mustafa Sercan03/2013; DOI:10.5350/DAJPN2013260109
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ABSTRACT: Mechanical restraint (MR) is a major infringement on the psychiatric patient’s autonomy. MR can cause physical and mental harm but may be necessary, e.g. to avoid putting an individual’s health at risk. The nursing staff is tasked with protecting the life and health of not only the individual patient but also other patients and relatives. A situation can occur in which staff is obligated to use force and occasionally MR, e.g. if a patient is very aggressive, violent, self-destructive or suicidal. Although MR is legal, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment concluded, in two reports from 2002, 2008, and 2014 that no medical justification exists for applying instruments of physical restraint to psychiatric patients for days and that doing so amounts to ill treatment. Although the number of MR episodes should be reduced as much as possible, how this goal should be accomplished is quite unclear. Despite the growth in available research in the area decisive evidence is still lacking. No studies have investigated which of the many MR-preventive factors are the most effective in practice, in Denmark and Norway. Therefore, the overall objective of this thesis was to generate knowledge of non-medical MR-prevention. The four studies that contributed to this objective had separate purposes. First, a systematic review of international research papers was conducted to identify evident and effective MR-preventive factors; this review served as a basis for developing a questionnaire examining the degree to which MR-preventive factors have been implemented in psychiatric units and the numbers of MR episodes in those units. Second, a comparative investigation of European countries was conducted to identify a country comparable to Denmark to include in the cross-country questionnaire survey. Third, the collected questionnaire data were analysed to identify the associations between the MR-preventive factors and the number of MR episodes. Finally, the data were analysed to identify if the MR-preventive factors could explain the difference in the number of MR episodes between Denmark and Norway. Three MR-preventive factors were significantly associated with a low frequency of MR episodes in Denmark and Norway: a mandatory review of MR episodes (64% fewer MR episodes), patient involvement (58% fewer MR episodes), and crowding (46% fewer MR episodes). Further, we identified five MR-preventive factors with confounding effects (reducing the difference between countries), which may explain in part why Denmark used 92% more MR compared with Norway. These factors included: staff education (51% of the effect), substitute staff (17% of the effect), work environment (15% of the effect), patient-staff ratio (11% of the effect), and identification of patients’ crisis triggers (10% of the effect). These results have increased our understanding of the ability of specific MR-preventive factors to reduce the number of MR episodes in Denmark and Norway, thereby generating knowledge in the field of MR-prevention. These findings have not been identified via randomised controlled trials (RCTs), and although some biases could be present, the questionnaire was thoroughly developed to include several potential confounders. Furthermore, similar results have been demonstrated in previous international studies. These factors are not likely to have adverse effects on the patients or staff. Rather, the potential positive effects of these factors on the prevention of MR episodes may reflect a general strengthening of the care and treatment environments. Therefore, further investigation into the effects of implementing the following within Danish and Norwegian practices is recommended: mandatory review, patient involvement, less crowding, higher staff education, less substitute staff use, better work environment, increased number of staff per patient, and the identification of the patient’s crisis triggers.03/2015, Degree: PhD, Supervisor: Mette Brandt-Christensen
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ABSTRACT: Background: Australia is committed to reduce or eliminate the use of containment measures (seclusion and restraint) in mental health care. International research suggests that number of containment events and hours spent in containment are often concentrated in a small number of patients. Understanding the concentration of containment episodes can support the development of effective interventions. Objectives: The purpose of this study is to explore the distribution and frequency of seclusion and restraint events and hours in adult inpatient mental health units in South Australia. Design: A retrospective audit of seclusion and restraint events during the time period 1/1/2010–31/12/2011. Setting: Eighteen (18) inpatient mental health units in South Australia. Results: Containment events were concentrated among a relatively small proportion of patients (10% of patients accounting for nearly 40% of events), with the concentration even more evident for containment hours (10% of patients accounting for over 50% of hours). Rates of containment varied widely between units. The highest rates were in high dependency units, which also accounted for over 90% of patients with the highest percentage of events and hours. More males than females experienced containment, with a significantly larger proportion of males experiencing the highest number of hours in containment. Conclusions: The concentration of containment events supports the validity of tailoring interventions, such as structured short-term risk assessment tools, reviewing repeat events and debriefing, to high-risk cases. These strategies should be used in conjunction with hospital-wide strategies with demonstrated efficacy, for example leadership, education, consumer involvement and data analysis.Collegian Journal of the Royal College of Nursing Australia 04/2015; DOI:10.1016/j.colegn.2015.03.006 · 0.84 Impact Factor