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

Area of Science:

• Psychiatry
• Healthcare Quality Improvement
• Patient Safety

Background:

• Seclusion and restraint (S/R) are used in psychiatric settings, but their overuse raises safety concerns.
• Initiatives to reduce S/R are crucial for improving patient care and therapeutic environments.

Purpose of the Study:

• To evaluate the effectiveness of a quality and safety initiative aimed at decreasing seclusion and restraint use.
• To assess the impact of evidence-based practices on S/R incidence and duration in a psychiatric service.

Main Methods:

• A pilot study analyzed S/R data from a 120-bed psychiatric service before and after intervention implementation.
• The intervention included the Brøset Violence Checklist, staff education in crisis intervention and trauma-informed care, frequent physician reassessments, administrative reviews, and environmental enhancements.
• Statistical analyses compared S/R incidence and duration between the intervention period (n=8029) and baseline (n=3884).

Main Results:

• The intervention was associated with a statistically significant decrease in the number of seclusions (p < 0.01).
• A significant reduction in the duration of seclusion per admission was also observed (p < 0.001).

Conclusions:

• The implemented quality and safety initiative was effective in reducing the use of seclusion in psychiatric services.
• Further research is needed to assess the generalizability of these findings, the contribution of individual intervention components, and the long-term impact on restraint use.