Special Section on Seclusion and Restraint: Pennsylvania State Hospital System's Seclusion and Restraint Reduction Program

Smith, Gregory M.; Davis, Robert H.; Bixler, Edward O.; Lin, Hung Mo; Altenor, Aidan; Altenor, Roberta J.; Hardentstine, Bonnie D.; Kopchick, George A.

doi:10.1176/appi.ps.56.9.1115

Cited by 252 publications

(159 citation statements)

References 29 publications

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“…Structured response teams, such as PERT, ensured fidelity to state polices and safe responses to psychiatric crises by placing the most experienced staff available at the scene of a crisis (3,24,25). In 2004, a statewide committee was formed to assess this staff training curriculum.…”

Section: System Changesmentioning

confidence: 99%

“…Among these efforts is the Pennsylvania State Hospital Seclusion and Restraint Reduction Program. The program cited the effectiveness of response teams, staff training, data transparency, treatment malls, leadership, and advocacy in helping the hospitals reduce the use of containment measures (3). In addition, the National Association of State Mental Health Program Directors (NASMHPD) issued Six Core Strategies for Reducing Seclusion and Restraint Use (4).…”

mentioning

confidence: 99%

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

Smith¹,

Ashbridge²,

Davis³

et al. 2015

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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.

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Section: System Changesmentioning

confidence: 99%

mentioning

confidence: 99%

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

Smith¹,

Ashbridge²,

Davis³

et al. 2015

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“…Three studies described staffing levels in terms of the ratio of staff to patients. In one, a decrease in hospital beds over a decade was accompanied by an increase in staff numbers (30). Two studies from the same state psychiatric hospital found statistically significant correlations between higher staffpatient ratios and lower use of seclusion and restraint (15,18).…”

Section: Staffingmentioning

confidence: 99%

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

Stewart

Merwe

Bowers

et al. 2010

Issues in Mental Health Nursing

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link ObjectiveThis review examines nature and effectiveness of interventions to reduce the use of mechanical restraint and seclusion among adult psychiatric inpatients. MethodElectronic searches were conducted to locate post-1960 empirical studies of restraint and seclusion reduction in English. A total of 36 studies were identified, mostly from the USA. Analysis was conducted using a structured data extraction tool. ResultsThe majority of studies reported reduced levels or mechanical restraint and/or seclusion, but the standard of evidence was poor. There were no randomised trials.Most were retrospective studies of official records before and after the intervention was introduced, with varying follow-up periods. The interventions were diverse, but tended to include one or more of the following: new restraint and/or seclusion policies, staffing changes, staff training, review procedures and crisis management initiatives. The research was unable to address which of these elements was most effective. There was also evidence that some improved outcomes were achieved by substituting restraint or seclusion for each other or for alternatives forms of containment (medication in particular). Nurses' attitudes, skills and approach to patient care were absent from the literature. Conclusions 3Interventions probably can reduce the use of restraint and seclusion, but better designed research is required to demonstrate their effectiveness conclusively. More attention should also be paid to understanding how interventions work, particularly from the perspective of nursing staff. This is essential to the successful implementation of restraint and seclusion interventions across different psychiatric settings and treatment populations.4

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“…Des traitements médicamenteux, par leur effet sur l'agitation et l'hostilité, ont montré qu'ils peuvent également contribuer à réduire l'utilisation de l'isolement ou d'autres mesures de contrainte [17,18]. Mais le problème demeure de la prise volontaire d'un médicament ou son administration sans le consentement du patient.…”

Section: Les Mesures Alternativesunclassified

“…Cependant, un grand nombre d'études descriptives et empiriques montrent, par un lien de causalité implicite, l'efficacité de différents types d'interventions sur la réduction des taux d'isolement [22]. Issus des réflexions de cliniciens mais aussi de pressions au niveau politique ou associatif, des programmes sont développés pour diminuer l'usage de la contrainte et de l'isolement [18,23,24], dont certains visent explicitement à les éli -miner. Ces initiatives alimentent la polémique et la controverse parmi les professionnels, comme l'illustre l'échange de lettres paru sur le site Psychiatric Services [25].…”

Section: Des Acquis Et Des Incertitudesunclassified

Les chambres fermées en psychiatrie: poursuivre le débat pour dépasser les conflits

2009

Swiss Arch Neurol Psychiatr

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Special Section on Seclusion and Restraint: Pennsylvania State Hospital System's Seclusion and Restraint Reduction Program

Abstract: Many factors contributed to the success of this effort, including advocacy efforts, state policy change, improved patient-staff ratios, response teams, and second-generation antipsychotics.

Cited by 252 publications

References 29 publications

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

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

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

Les chambres fermées en psychiatrie: poursuivre le débat pour dépasser les conflits

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