Reduction of Seclusion and Restraint in an Inpatient Psychiatric Setting: A Pilot Study

Abstract

The authors describe a quality and safety initiative designed to decrease seclusion/restraint (S/R) and present the results of a pilot study that evaluated the effectiveness of this program. The study sample consisted of consecutive admissions to a 120-bed psychiatric service after the intervention was implemented (October 2010-September 2012, n = 8029). Analyses compared S/R incidence and duration in the study sample to baseline (consecutive admissions during the year prior to introduction of the intervention, October 2008-September 2009, n = 3884). The study intervention, which used evidence-based therapeutic practices for reducing violence/aggression, included routine use of the Brøset Violence Checklist, mandated staff education in crisis intervention and trauma informed care, increased frequency of physician reassessment of need for S/R, formal administrative review of S/R events and environmental enhancements (e.g., comfort rooms to support sensory modulation). Statistically significant associations were found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001). These preliminary results support the conclusion that this intervention was effective in reducing use of seclusion. Further study is needed to determine if these prevention strategies are generalizable, the degree to which each component of the intervention contributes to improve outcome, and if continuation of the intervention will further reduce restraint use.

Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme (‘REsTRAIN YOURSELF’)

“…The significant reduction in restraint rates between the two phases is in line with that reported by Putkonen et al (2013) in their Randomised Control Trial in a high secure forensic setting in Finland. They found a scale of reduction (29% in rates per 100 beds/observation days) to be substantial exceeding that reported by Blair et al (2017) and Lewis et al (2009) in their respective studies. Statistically significant associations were also found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001).…”

“…This promotes the recognition of service users' existing trauma, as opposed to relying upon readily available coercive measures (Hernandez et al 2017, Blair et al 2017. With additional investment in overall resources and managerial support to minimise the use of practices such as restraint, as advocated by and as seen in the work of Riahi et al (2016), even better outcomes might be possible, The use of feasibility studies to explore and evidence usable and acceptable approaches to implement the Six Core Strategies in different geographical and practice settings in the future would be welcomed.…”

The effect of psychoeducation given to psychiatry nurses on level of knowledge, attitudes, and practices regarding physical restraint: A randomized controlled study

“…Furthermore, psychoeducation focuses on individual strengths, concentrating on the present and future, instead of on the past. Psychoeducation programs are presented in a variety of formats and can be offered for an hour or a day, or on a weekly, monthly or annual basis . Primary, secondary, and tertiary preventive health care services can be administered psychoeducation.…”

“…Psychoeducation programs are presented in a variety of formats and can be offered for an hour or a day, or on a weekly, monthly or annual basis. 5,21 Primary, secondary, and tertiary preventive health care services can be administered psychoeducation. Coping with stress, strengthening interfamily processes, and raising awareness about social problems are among the primary preventions targeted by psychoeducation.…”

“…Of the nurses in the control group, 42% (24) were between the ages of 26 and 33, 72.0% (42) were female, 64.0% (37) had completed a license program, 79.0% (46) were married, 53.0% (31) had been working for 12 to 17 years. Of the nurses in the experimental group, 40% (21) were between the ages of 26 and 33, 70.0% (37) were female, 64.0% (34) had completed a license program, 79.0% (42) were married, 52.0% (28) had been working for 12 to 17 years. The control and experimental group nurses were homogeneous in terms of descriptive characteristics (P > .05, Table 1).…”