Evaluation of the effect of a structured intervention for the management of behavioural disturbance on the level of seclusion in an acute psychiatric inpatient ward

Abstract

Background: Seclusion in psychiatric inpatient settings is contentious, and services attempt to minimize its use. Many studies compare seclusion rates before and after the introduction of an intervention, but few control for the effect of external factors such as legislative constraints and patient characteristics.Aims: To evaluate the effect of a programme designed to manage acute arousal.Method: Seclusion rates in a six-month period incorporating a programme to manage acute arousal were compared with the previous six months. The intervention focused on formal assessment of arousal levels and an escalating set of actions by nursing staff.Results: Seclusion rates in the two periods were comparable, both before and after controlling for patient characteristics. Duration of seclusion events appeared to be heavily influenced by local legislative constraints. Conclusions:A programme designed to reduce seclusion showed no difference from baseline after taking various factors into account. This may have been at least partly because most seclusion events occurred early in an admission. Many patients arrive on the unit already requiring seclusion, and any impact of a ward programme on them is limited. Since seclusion is a comparatively uncommon event, and attributable to a minority of patients, appropriate analytic methods are required.

People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

“…; Trauer et al . ), three individual HoNOS items were predictive of seclusion, two HoNOS items were protective, and the cumulative number of these items was incrementally predictive.…”

“…People with clinically significant scores on these HoNOS items were less likely to be secluded, as also observed in Australia (Trauer et al . ). Simpson et al .…”

“…; Trauer et al . ). This may reflect the different population groups, smaller sample sizes, and scoring systems used in these studies.…”

“…Another smaller Australian study (Trauer et al . ) found some individual HoNOS item ratings were higher among people who experienced seclusion. Similar findings were reported in a larger study of people involuntarily admitted to acute psychiatric departments across Norway (Husum et al .…”

The comparative efficacy of intramuscular antipsychotics for the management of acute agitation

“…Such presentations are associated with a high risk to self and others. Non-pharmacological interventions such as verbal expression of thoughts and feelings, redirection and time out 1,2 may not be effective in a safe timeframe. Risks of antipsychotic therapy, in this context, may include prolonged QTc interval and sudden death, 3,4 and extrapyramidal side-effects such as acute dystonias.…”