A regional multicomponent intervention for mechanical restraint reduction in acute psychiatric wards

Abstract

Accessible summary What is known on the subject? A relevant number of restraint prevention programmes have been developed internationally. In Spain, there is no harmonized policy to prevent the use of restraint. More studies are necessary to establish which programmes and components are necessary to prevent restraint. What does the paper add to existing knowledge? There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention. There was no significant decreasing trend in the number of mechanical restraint episodes. What are the implications for practice? Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context. All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. Abstract IntroductionMechanical restraint (MR) is used in many countries, including Spain, where non‐harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. AimTo analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. MethodEpisodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. ResultsThere were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (−1.79%, p < .001), but not in the number of restraint episodes (−0.45%; p = .149). DiscussionThe results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for PracticeInterventions at a regional level aimed at preventing MR are feasible in the Spanish context.

Relationship between nurses' use of verbal de‐escalation and mechanical restraint in acute inpatient mental health care: a retrospective study

“…As in other studies, the profile of the patient who underwent mechanical restraint was higher in men than in women (Al‐Maraira & Hayajneh 2019; Guzman‐Parra et al . 2020; Knutzen et al . 2011; Lantta et al .…”

“…2020) and the mean age was around 40 years old (Guzman‐Parra et al . 2020; Jury et al . 2019; Lantta et al .…”

“…Furthermore, the most frequent diagnosis was schizophrenia (Guzman‐Parra et al . 2020; Iozzino et al . 2015; Knutzen et al .…”

“…The scientific literature repeatedly points to the need to find alternatives to the use of restraints in mental health hospital settings because of the negative impact on both patients and nurses (Aguilera-Serrano et al 2018;Jury et al 2019;McKeown et al 2019;Thomann et al 2021). Numerous studies report negative experiences related to these practices and provide the scientific community with alternatives to the use of these measures (Fern andez-Costa et al 2020;Guzman-Parra et al 2020). Thus, verbal de-escalation has been highlighted as the main strategy for the control of preagitation states due to its high patient acceptance and its positive impact on the feelings of health professionals, patients, and health institutions (Kuivalainen et al 2017;Price et al 2018).…”

Overcoming the Use of Mechanical Restraints in Psychiatry: A New Challenge in the Everyday Clinical Practice at the Time of COVID-19

“…It is imperative and crucial to improve knowledge and adequately train hospital staff in psychiatric wards, but also in all wards potentially involved in the use of MR, with appropriate methods [40,41]. Staff training and selection are an effective measure to minimize MR's duration and adverse effects, and we recommend conducting a compulsory training program to reduce unnecessary restraint [42,43].…”