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Restraint Reduction at a Pediatric Psychiatric Hospital: A Ten-Year Journey
Muhammad Waqar Azeem1,2, Bhagya Reddy1,2, Marianne Wudarsky1,2
1Albert J. Solnit Children's Center, Middletown, CT, USA.
Insights
A 10-year quality improvement project successfully eliminated mechanical restraints and significantly reduced physical restraints in a pediatric psychiatric hospital by implementing trauma-informed care and staff training.
Area of Science:
- Child and Adolescent Psychiatry
- Quality Improvement Science
- Trauma-Informed Care
Background:
- Restraints are utilized as safety interventions for pediatric patients in various settings.
- Adverse effects of restraints include injuries and, in some cases, death.
- Reducing restraint use is crucial for patient safety and well-being.
Purpose of the Study:
- To decrease the use of mechanical and physical restraints in a pediatric psychiatric hospital.
- To implement trauma-informed and strength-based care principles.
- To foster a positive culture change and improve patient outcomes.
Main Methods:
- Utilized primary prevention principles rooted in trauma-informed and strength-based care.
- Engaged hospital leadership to drive cultural transformation.
- Provided staff training on restraint reduction and prevention techniques.
- Implemented debriefing and problem-solving protocols.
- Involved youth and families in treatment planning to enhance relationships and communication.
Main Results:
- Achieved a 100% reduction in mechanical restraints over 10 years (2005-2014).
- Reduced physical restraints by 88% from 2005 to 2014.
- Sustained zero mechanical restraints for the last 3 years of the study period.
Conclusions:
- A comprehensive quality improvement initiative can effectively eliminate mechanical restraints and significantly reduce physical restraints.
- Trauma-informed care, staff training, and family involvement are key components of successful restraint reduction strategies.
- The project demonstrated the feasibility of providing safe, effective, and restraint-free care in a pediatric psychiatric setting.
Background:
Restraints are used as one of the safety interventions for children and adolescents in various community, hospital, and treatment settings. Although considered safety interventions, restraints are known to have many adverse effects on children and staff, including injuries; even reports of death are noted in the literature.
Objective:
In an effort to reduce the use of restraints and to provide trauma-informed care in a 52-bed Pediatric Psychiatric Hospital, a quality improvement project was launched.
Interventions:
Primary prevention principles based on trauma-informed and strength-based care were utilized to provide care for children and adolescents. Hospital leadership played an instrumental role in bringing positive culture change. Staff involvement and training in restraint reduction and prevention tools played a key role in this project. Debriefing and problem solving were effective interventions for the prevention of restraints. Involvement of youth and family in treatment planning built stronger relationships with staff and paved the way for better communication and trust, and improved understanding of strengths and needs of children and adolescents.
Results:
Over a 10-year period, mechanical restraints decreased by 100%, from 485 in 2005 to "zero" in 2014 and none in the last 3 years. Physical restraints decreased by 88%, from 3,033 in 2005 to 379 in 2014.
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