The 'S&R challenge': reducing the use of seclusion and restraint in a state psychiatric hospital

The Colorado Mental Health Institute at Pueblo (CMHIP) established a performance improvement initiative to reduce the frequency and length of episodes of seclusion, restraint, or both (S&R). The initiative, the S&R Challenge, is a systematic approach to identifying the root causes of the S&R problem and developing solutions to identified causes. CMHIP successfully reduced t h e numberand length of S&R episodes, improved the quality of S&R documentation in the medical record, and passed three surveys by major regulatory bodies with no S&R deficiencies.