Reducing seclusion and restraint: meeting the organizational challenge

The Mohawk Valley Psychiatric Center has experienced a major reduction in the use of seclusion and restraint in the past five years. It has used the traditional quality improvement (QI) tools like the Plan Do Check Act, Flowcharts, Fishbone diagrams, and Parieto Charts as suggested in the QI literature. The original work to reduce seclusion and restraint are described in two previous articles by Visalli and McNasser. This article describes the additional work since that time. The seclusion/restraint rate in adult service per 1,000 patient days is 0.13 for restraint and 0.15 for seclusion for calendar year 1998. Children and youth service also has comparatively minimal use of seclusion and restraint. The success of this program is attributed to the organizational leadership and the interdisciplinary approach taken to provide individualized treatment. Many of the initiatives stem from a working relationship with patients on how to improve customer service.