Elements of Successful Restraint and Seclusion Reduction Programs and Their Application in a Large, Urban, State Psychiatric Hospital

Creedmoor Psychiatric Center and Columbia University College of Physicians and Surgeons, Queens Village, New York 11427, USA.
Journal of Psychiatric Practice (Impact Factor: 1.34). 02/2003; 9(1):7-15. DOI: 10.1097/00131746-200301000-00003
Source: PubMed


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.

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    • "As well, Mayers, Keet, Winkler, and Flisher (2010) have found that patients experience greater distress when PSRR is not conducted. On the whole, according to the research, PSRR is highly recommended and vital to improving the care experience for both patient and staff, developing best practices, and reducing the incidence of SR (Bonner, 2008; Fisher, 2003; Huckshorn, 2004; Needham & Sands, 2010; Pollard, Yanasak, Rogers, & Tapp, 2007; Taxis, 2002; Taylor & Lewis, 2012). The practice is widely promoted in SR guidelines, although its effects have not yet been reported in a systematic review. "
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    ABSTRACT: Context: It has been suggested that after an incident in which a patient has been placed in seclusion or in restraints, an intervention should be conducted after the event to ensure continuity of care and prevent recurrences. Several terms are used, and various models have been suggested for post-seclusion and/or restraint review; however, the intervention has never been precisely defined. Objective: This article presents a scoping review on post-seclusion and/or restraint review in psychiatry to examine existing models and the theoretical foundations on which they rely. Method: A scoping review of academic articles (CINAHL and Medline database) yielded 28 articles. Results: Post-seclusion and/or restraint review has its origins in the concepts of debriefing in psychology and reflective practice in nursing. We propose a typology in terms of the intervention target, including the patient, the health care providers, or both. Implications: The analysis found that the review ought to involve both the patient and the care providers using an approach that fosters reflexivity among all those involved in order to change the practice of seclusion in psychiatric settings. Accessible summary: •Established literature documented widely that seclusion and restraint has adverse physical and psychological consequences for patient and for health care providers.•Post-seclusion and/or restraint review is promoted in most guidelines, but there is no scoping or systematic review yet on the subject.•The origins of post-seclusion and/or restraint review are in the concepts of debriefing in psychology and reflective practice in nursing.•We propose that post-seclusion and/or restraint review should focus on both patients and health care providers.•Systematic post-seclusion and/or restraint review should be performed after each event, and its effects on patients and on mental health professionals should be rigorously assessed.
    Full-text · Article · Sep 2015
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    • "Indeed, even when risk assessment measures are used in the clinical setting, absconding risk is often not included (Gerace et al. 2013a). Reliable and valid data should drive any risk-profile formulation and evidencebased nursing interventions to reduce absconding (Fisher 2003; Mosel et al. 2010a). Two literature reviews, together covering the period 1950–2008 (Bowers et al. 1998; Muir-Cochrane & Mosel 2008), indicate characteristics of people who abscond being young, male, single, from disadvantaged groups, involuntarily hospitalized or from police/court referral, and with a diagnosis of schizophrenia. "
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    ABSTRACT: Absconding, where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. However, Australian data to drive nursing interventions remain sparse. The purpose of this retrospective study was to investigate absconding in three acute care wards from January 2006 to June 2010, in order to determine absconding rates, compare patients who did and did not abscond, and to examine incidents. The absconding rate was 17.22 incidents per 100 involuntary admissions (12.09% of patients), with no significant change over time. Being male, young, diagnosed with a schizophrenia or substance-use disorder, and having a longer hospital stay were predictive of absconding. Aboriginal and Torres Strait Islander patients had higher odds of absconding than Caucasian Australians. Over 25% of absconding patients did so multiple times. Patients absconded early in admission. More incidents occurred earlier in the year, during summer and autumn, and later in the week, and few incidents occurred early in the morning. Almost 60% of incidents lasted ≤24 hours. Formulation of prospective interventions considering population demographic factors and person-specific concerns are required for evidence-based nursing management of the risks of absconding and effective incident handling when they do occur.
    Full-text · Article · Feb 2015 · International journal of mental health nursing
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    • "Consequently , there has been a worldwide move toward the reduction or elimination of both restraint and other containment practices, such as seclusion, in mental health care (Department of Health 2008; Te Pou 2008). Effective initiatives to reduce restraint are described in the published work (Evans et al. 2002; Fisher 2003), but there remain variations in use and attitudes towards containment measures (Bowers et al. 2007), and the need for organizational and philosophical shifts in restraint reduction efforts have been identified (Ashcraft & Anthony 2008). "
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    ABSTRACT: Restraint of older persons in inpatient and residential care is used to control aggression, and prevent falls and other adverse outcomes. Initiatives to reduce these practices are being implemented worldwide. However, there has been little examination of restraint practice in psychiatric services for older persons. This paper reports a retrospective comparative analysis of restraint use in three acute and two extended care psychiatric inpatient wards in Australia. The analysis involved examination of restraint incidents and comparison of restrained and non-restrained patients. There was significant variation in restraint use between wards. On one acute ward, 12.74% of patients were restrained, although restraint use declined during the data collection period. Patients with dementia were restrained at higher rates than patients with other diagnoses, and restrained patients stayed in hospital for a longer duration. Restraint occurred early in admission, and few differences emerged between those restrained once or multiple times. Mechanical restraint was more prevalent than physical restraint, with restraint predominantly used to manage aggression and falls. Findings provide new data on restraint in older persons' psychiatric services. Greater conceptual understandings of behaviours associated with dementia and the unique needs of patients with these disorders may assist in reducing restraint use in these settings.
    Full-text · Article · Dec 2013 · International journal of mental health nursing
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