Clinical and Organizational Factors Related to the Reduction of Mechanical Restraint Application in an Acute Ward: An 8-Year Retrospective Analysis

Abstract

Background: The purpose of this study was to describe the frequency of mechanical restraint use in an acute psychiatric ward and to analyze which variables may have significantly influenced the use of this procedure. Methods: This retrospective study was conducted in the Servizio Psichiatrico di Diagnosi e Cura (SPDC) of Modena Centro. The following variables of our sample, represented by all restrained patients admitted from 1-1-2005 to 31-12-2012, were analyzed: age, gender, nationality, psychiatric diagnoses, organic comorbidity, state and duration of admission, motivation and duration of restraints, nursing shift and hospitalization day of restraint, number of patients admitted at the time of restraint and institutional changes during the observation period. The above variables were statistically compared with those of all other non-restrained patients admitted to our ward in the same period. Results: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts. Neurocognitive disorders, organic comorbidity, compulsory state and long duration of admission were statistically significantly related to the increase of restraint use (p<.001, multivariate logistic regression). Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression). Conclusion: The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach.

Predicting mechanical restraint of psychiatric inpatients by applying machine learning on electronic health data

“…Patients admitted involuntarily typically display psychotic symptoms, lack of insight, and aggression. Such behaviour has previously been associated with increased risk of MR .…”

A pilot study of “post-seclusion and/or restraint review” intervention with patients and staff in a mental health setting

“…PSRR offers the possibility for patients and staff to improve the quality of care as well as the safety of the ward, specifically by promoting not only a reduction in SR use but also, most likely, a reduction in ward violence, as some studies have highlighted. 24,25 PSRR seems to provoke reflections for everyone involved, which foster mutual learning and changes in practice, as illustrated by the significant reduction in both hours spent in seclusion and proportion of patients exposed to seclusion. Our study contributes to increasing the breadth of knowledge on the aftermath of SR as well as to evidenced-based practice.…”

Investigation of Aggression and Restriction Methods in Psychiatric Settings of a Training and Research Hospital

“…Kullanýlan yöntemler arasýnda fiziksel ve mekanik kýsýtlama, izolasyon, oral yada intramüsküler ilaç tedavileri yer almaktadýr (13). Kliniðe kabul sonrasý birinci gün, en fazla mekanik kýsýtlama yönteminin kullanýldýðý belirtilmektedir (14). Türkiye'de en sýk kullanýlan yöntemlerin ise mekanik kýsýtlama, izo-lasyon ve intramüsküler sedasyon olduðu belirtilmektedir (15 Agresyon ve þiddet olaylarý ortamda bulunan herkesi etkileyebilmektedir.…”

“…(31). Bir diðer çalýþmada da mekanik tespitin agresif davranýþý yönetmede, çoðunlukla yatýþýn ilk günlerinde ve gece uygulandýðý belirtilmektedir (14). Bu çalýþma açýsýndan da olaylarýn çoðunda kontrol yöntemi kullanýlmamasý ve mekanik tespitle birlikte uygulanan intramüsküler hibernasyonun daha az olmasý olumlu olarak deðerlendirilebilir.…”