Reducing Mechanical Restraints in Acute Psychiatric Care Settings Using Rapid Response Teams

Abstract

This article describes the use of rapid response teams to reduce the use of mechanical restraints (i.e., restricting a person's movement through the use of a mechanical device such as a backboard, net, or papoose) in an acute psychiatric care setting. Rapid response teams have proven highly effective for emergent medical patients, but have not typically been used in behavioral health care settings. Utilizing a rapid cycle process improvement approach, a response team was convened following each episode of mechanical restraint in an inpatient psychiatric treatment facility. Initial results, during a 6-week rapid cycle change process, showed that mechanical restraints were reduced by 36.4% when compared with a 6-week baseline and when compared with a 1-year baseline. Changes in hospital census during the implementation process did not appear to account for the reduction in restraints. Rapid response teams and rapid cycle process improvement are discussed as useful change vehicles for behavioral health care organizations.

A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

“…In another, response teams to review restraint episodes was reported to improve supervision, communication between staff members at different levels and opportunities to discuss individual patient's treatment plans (40). These provide anecdotal evidence of teamwork skill and apparent positive attitude leading to lower restraint and seclusion, but were not examined explicitly by any study.…”

“…The review process was the primary aim of the intervention in another study (i.e. it focused on repeated restraint only), which found a reduction in restraint episodes from 21 per 1000 bed days to 14 over a 12 week period (40).…”

“…All three studies reporting the number of patients restrained found no reductions (36,40,46). Restraint episodes, often averaged by month and/or patient, were the most common outcome measure and almost all the studies using it reported a reduction (30,32,37,40,43,44,48).…”

“…Restraint episodes, often averaged by month and/or patient, were the most common outcome measure and almost all the studies using it reported a reduction (30,32,37,40,43,44,48). There was no significant change in one study (45), while another study showed an apparent increase (29).…”

Using a NIATx based local learning collaborative for performance improvement

“…Treatment agencies have used the NIATx model to focus their efforts on implementation of business practices to reduce waiting times and increase continuation in treatment (Hoffman, Ford, Choi, Gustafson, & McCarty, 2008; McCarty et al, 2007; Wisdom, Hoffman, Rechberger, Seim, & Owens, 2009). The NIATx model has also helped improve patient care in behavioral health systems (Prescott, Madden, Dennis, Tisher, & Wingate, 2007). A recent NIATx initiative, Advancing Recovery, expanded the NIATx model to test its usefulness in the implementation of evidence-based practices (EBPs) related to pharmacological and behavioral therapies among chemical dependency providers and to create changes at state and payer levels that would encourage EBP adoption (Bornemeier, 2010).…”