Implementation of the Six Core Strategies for Restraint Minimization in a Specialized Mental Health Organization

Abstract

Implementation of the Six Core Strategies to Reduce the Use of Seclusion and Restraint (Six Core Strategies) at a recovery-oriented, tertiary level mental health care facility and the resultant changes in mechanical restraint and seclusion incidents are described. Strategies included increased executive participation; enhanced staff knowledge, skills, and attitudes; development of restraint orders and decision support in the electronic medical record to enable informed debriefing and tracking of events; and implementation of initiatives to include service users and their families in the plan of care. Strategies were implemented in a staged manner across 3 years. The total number of mechanical restraint and seclusion incidents decreased by 19.7% from 2011/12 to 2013/14. Concurrently, the average length of a mechanical restraint or seclusion incident decreased 38.9% over the 36-month evaluation period. Implementation of the Six Core Strategies for restraint minimization effectively decreased the number and length of mechanical restraint and seclusion incidents in a specialized mental health care facility. [Journal of Psychosocial Nursing and Mental Health Services, 54(10), 32-39.].

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

“…There was a 19.7% decrease in the number of restraint and seclusion incidents, a 42.3% decrease in the total restraint and seclusion hours, and a 38.9% decrease in the average hours per restraint or seclusion from the 2011/2012 fiscal year to the 2013/2014 fiscal year [18]. …”

“…To align practices with recovery values, a policy supporting least restraint and seclusion was implemented [18]. Decision support was embedded directly within the physician orders for restraint and seclusion, and appropriate documentation of best practices were reflexed for clinical staff.…”

Multidimensional approach to restraint minimization: The journey of a specialized mental health organization

“…While other strategies aimed towards restraint minimization had been implemented prior to and during the follow‐up period of the present study (Riahi et al . ), regression analysis of the effects of multidimensional restraint‐minimization strategies in a similar public hospital specializing in the treatment of serious and persistent mental illness showed that administrative review of practices was the most important strategy (Donat ). This suggests that despite changing factors in the hospital, recovery rounds were an important initiative that affected restraint practices.…”

“…For most measures, however, analysis showed a change in the trends for seclusion and restraint at the time of implementation. Visual examination of the corporate restraint and seclusion summary data showed a prominent change in overall restraint and seclusion hours in December 2012, when recovery rounds were implemented, which remained lower thereafter (Riahi et al 2016). Trends otherwise appeared relatively consistent, despite ongoing efforts towards restraint minimization.…”

“…A policy for minimization of restraint as a response to imminent risk of serious harm was developed to create clear expectations and promote the least restrictive, least intrusive care for service users, and to align practices with the ethical principles of autonomy, beneficence, and non-maleficence. The policy included implementation of a number of initiatives according to the six core strategies framework (Huckshorn 2004), which were implemented pragmatically according to organizational capacity (Riahi et al 2016). The present study focussed specifically on the implementation of strategy 1.…”