Lessons from an investigation of seclusion at an older adolescent inpatient unit

To determine the rate, indications and process for using seclusion for patients undergoing treatment at an older adolescent inpatient unit.

Data were gathered prospectively and retrospectively as part of a quality assurance initiative at the Christchurch Youth Inpatient Unit (YIU); paper, electronic and legal documentation were examined.

During the time period of the investigation, approximately 13% of individuals admitted to the unit were secluded. Psychosis, involuntary admission and Maori ethnicity were significantly associated with the use of seclusion with aggression being the most documented indication. The vast majority of seclusions occurred within the first seven days of admission and over half utilized pro re nata medication prior to seclusion.

Opportunities exist for intensifying and focusing efforts to minimize the use of seclusion and restraint, particularly during the first week of hospitalization.