Least restrictive measures: alternatives to four-point restraints and seclusion

Following the review and discussion of alternative measures in the use of four-point restraints and seclusion on an acute psychiatric inpatient unit, the staff increased the use of "least restrictive" measures with aggressive patients. This involved increased attention to escalating behavior and using alternatives. Although early recognition did not guarantee success in every situation, patients were included in making choices and being in control of which option to take. When staff became more knowledgeable about the use of alternatives, they were more comfortable offering patients choices and did not wait until restraints and seclusion were necessary. It was beneficial to review the rationale for the use of seclusion and restraints with both patients and staff. Specific approaches for early recognition and intervention focused on verbal control, limit setting, and decreased stimulation. It is important that staff have a clear understanding of their range of treatment strategies from most to "least restrictive" measures during stressful times when patients become confused, angry, or frightened and may lose control. Patients must be made aware of their choices during this cycle and understand the consequences of their behavior. Planning educational inservice programs for staff to address this content and share approaches to specific situations can be effective. Staff debriefing following an incident is crucial to discuss reactions to the use of restraints and seclusion and to plan for the use of alternative measures in the future. All patients need a chance to express themselves. As staff we must take time to stop, look, and listen. We must be aware of our own thoughts and feelings and think of choices. What are the ¿least restrictive¿ measures? We need to work with patients in considering a range of measures without taking unnecessary risks or disregarding issues. We must work with our patients so that we all can learn a valuable lesson. Why not give our patients a chance?