Correlation Between Reduction of Seclusion and Restraint and Assaults by Patients in Pennsylvania’s State Hospitals

Abstract

Objective: This prospective study assessed the use of seclusion and restraint in the Pennsylvania state hospital system from 2001 through 2010. It also examined the correlation between declining use of containment procedures and assaults by patients on other patients and staff.Methods: The 12,900 anonymized records involving the 1,801 unique, civilly committed individuals who were physically or mechanically restrained and secluded in the nine civil hospitals during this study period were entered into a database. The data set included demographic and diagnostic information about the patients and the cause and effect of the procedures. These data were compared with rates of patient-to-patient and patientto-staff assaults to determine any correlation between changes in use of containment and assaults.Results: From 2001 to 2010, the use of mechanical restraint significantly declined from .37 to .08 episodes per 1,000 days (p,.018), and the use of seclusion significantly declined from .21 to .01 episodes per 1,000 days (p,.001). Persons with an axis I diagnosis of psychotic disorder accounted for 44% of containment procedures used during this study. Patient-topatient assaults declined slightly, and patient-to-staff assaults were unaffected.Conclusions: Decreasing the use of containment procedures did not increase assaults. Better leadership, data transparency, use of clinical alerts, workforce development, policy changes, enhanced use of response teams, implementation of dialectical behavior therapy, and discontinuation of the psychiatric use of PRN orders contributed to the change in use of containment procedures. A philosophical change to a recovery model of psychiatric care and services was the driving force behind this transformation.

Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint

“…), although other research indicates restraint reduction is not necessarily associated with an increase in aggression (Smith et al . ). Further, existing research draws attention to the incidence of posttraumatic stress in nurses working in acute psychiatric inpatient settings being about 10% (Jacobowitz ).…”

“…Importantly, research has also reported that reduction in the use of restrictive practices does not lead to an increase in assaults (Smith et al . ). Building on these successes, the Restrictive Practice Working Group of the Australian Health Ministers’ Advisory Council developed the ‘National Principles to Support the Goal of Eliminating Mechanical and Physical Restraint in Mental Health Services’ () as the next logical step towards eliminating restrictive practices in Australia.…”

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

“…Interestingly, nurses have also reported to often feel relieved after the seclusion is over and concerned whether they did the right thing or failed to find alternative methods [33]. Researchers still disagree whether decreasing the use of seclusion results in increasing of violent incidents [39] or whether it has no effect [40] or a decreasing effect [41]. …”

Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review

“…Notably, levels of PRN use vary in different organizations (Baker et al 2008a;Molloy et al 2012) and some hospitals have successfully discontinued the use of psychotropic PRN (Smith et al 2015). Evidence exists that reducing PRN does not increase aggressive incidents (Friedman et al 2012;Hayes & Russ 2015;Smith et al 2008).…”