Brief Reports: A Program to Reduce Use of Physical Restraint in Psychiatric Inpatient Facilities

Department of Psychiatry, University of Illinois at Chicago, 104 South Michigan Avenue, Suite 900, Chicago, IL 60603, USA.
Psychiatric Services (Impact Factor: 2.41). 08/2004; 55(7):818-20. DOI: 10.1176/
Source: PubMed


The authors describe a program to reduce the use of physical restraint on three psychiatric units of a university hospital. One component of the program involved interviewing patients to determine their stress triggers and personal crisis management strategies. The second consisted of training staff members in crisis de-escalation and nonviolent intervention. During the first two quarters after implementation of the program, physical restraint rates declined significantly and remained low on all three units for the remainder of the year after implementation. Hospitals should consider instituting comprehensive staff training that encourages adaptive patient behaviors and nonviolent staff intervention to reduce the physical and mechanical restraint of children and adults in inpatient facilities.

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Available from: Judith A. Cook, Jul 25, 2014
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    • "The above strategies for decreasing seclusion and restraint worked well in inpatient hospital environments, and there are several other reports on successful reduction of seclusion or restraint.17–20 However, it may be unrealistic to expect these results in a psychiatric emergency service (PES) or emergency department (ED) setting, as they differ in clinical structure, purpose, and length of stay from an inpatient hospital unit. "
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    ABSTRACT: Issues surrounding reduction and/or elimination of episodes of seclusion and restraint for patients with behavioral problems in crisis clinics, emergency departments, inpatient psychiatric units, and specialized psychiatric emergency services continue to be an area of concern and debate among mental health clinicians. An important underlying principle of Project BETA (Best practices in Evaluation and Treatment of Agitation) is noncoercive de-escalation as the intervention of choice in the management of acute agitation and threatening behavior. In this article, the authors discuss several aspects of seclusion and restraint, including review of the Centers for Medicare and Medicaid Services guidelines regulating their use in medical behavioral settings, negative consequences of this intervention to patients and staff, and a review of quality improvement and risk management strategies that have been effective in decreasing their use in various treatment settings. An algorithm designed to help the clinician determine when seclusion or restraint is most appropriate is introduced. The authors conclude that the specialized psychiatric emergency services and emergency departments, because of their treatment primarily of acute patients, may not be able to entirely eliminate the use of seclusion and restraint events, but these programs can adopt strategies to reduce the utilization rate of these interventions.
    The western journal of emergency medicine 02/2012; 13(1):35-40. DOI:10.5811/westjem.2011.9.6867
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    • "These strategies and programmes have included teaching patients stress or anger management, training staff in crisis intervention and de-escalation techniques and routine review of the use of restraint and seclusion [6] [9] [13] [20]. This study does not provide support for the hypothesis that the level of procedural justice experienced at the time of admission predicts future engagement with service. "
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    ABSTRACT: We sought to determine the level of procedural justice experienced by individuals at the time of involuntary admission and whether this influenced future engagement with the mental health services. Over a 15-month period, individuals admitted involuntarily were interviewed prior to discharge and at one-year follow-up. Eighty-one people participated in the study and 81% were interviewed at one-year follow-up. At the time of involuntary admission, over half of individuals experienced at least one form of physical coercion and it was found that the level of procedural justice experienced was unrelated to the use of physical coercive measures. A total of 20% of participants intended not to voluntarily engage with the mental health services upon discharge and they were more likely to have experienced lower levels of procedural justice at the time of admission. At one year following discharge, 65% of participants were adherent with outpatient appointments and 18% had been readmitted involuntarily. Insight was associated with future engagement with the mental health services; however, the level of procedural justice experienced at admission did not influence engagement. This study demonstrates that the use of physical coercive measures is a separate entity from procedural justice and perceived pressures.
    European Psychiatry 05/2011; 26(4):208-14. DOI:10.1016/j.eurpsy.2010.01.014 · 3.44 Impact Factor
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    • "The evidence was mixed for the mean time in restraint. Four studies reported reductions (Currier & Farley-Toombs, 2002; Jonikas et al., 2004; Mallya et al., 1992; Smith et al., 2005), but three found no effect for the interventions (Carlson & Holm, 1993; Chengappa et al., 2000; Morrison et al., 2002). "
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    ABSTRACT: This review examines the nature and effectiveness of interventions to reduce the use of mechanical restraint and seclusion among adult psychiatric inpatients. Thirty-six post-1960 empirical studies were identified. The interventions were diverse, but commonly included new restraint or seclusion policies, staffing changes, staff training, case review procedures, or crisis management initiatives. Most studies reported reduced levels of mechanical restraint and/or seclusion, but the standard of evidence was poor. The research did not address which programme components were most successful. More attention should be paid to understanding how interventions work, particularly from the perspective of nursing staff, an issue that is largely overlooked.
    Issues in Mental Health Nursing 06/2010; 31(6):413-24. DOI:10.3109/01612840903484113
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