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Published in: Psychiatric Quarterly 1/2007

01-03-2007 | Original Paper

Organizational and Unit Factors Contributing to Reduction in the Use of Seclusion and Restraint Procedures on an Acute Psychiatric Inpatient Unit

Authors: Richard Pollard, Ph.D., Elisia V. Yanasak, Ph.D., Steven A. Rogers, Ph.D., André Tapp, M.D.

Published in: Psychiatric Quarterly | Issue 1/2007

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Abstract

Objective

The use of seclusion or restraint (S/R) as an emergency medical intervention to assist patients in regaining behavioral control continues to be an area of interest and concern for the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), consistent with the ongoing concerns in the medical, patient advocate, legislative and legal communities. This study examined unit characteristics and the use of S/R in a VA facility with a secured, acute mental health unit before and after the promulgation of the JCAHO 2000 standards for utilization of S/R for behavioral health reasons.

Methods

Variables examined include patient acuity, patient census, number of admits, number of discharges, length of stay, number of nursing staff on duty, critical incidents and S/R hours per month.

Results

Results indicated S/R use began showing a notable decrease corresponding to the time that senior unit management began discussions of the new JCAHO standards. These reductions maintained statistical significance even after controlling for changes in unit environmental variables.
Literature
1.
go back to reference Joint Commission on Accreditation of Healthcare Organizations: Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, Illinois, Joint Commission Resources, 2000. Joint Commission on Accreditation of Healthcare Organizations: Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, Illinois, Joint Commission Resources, 2000.
2.
go back to reference Allen MH, Currier GW: Use of restraints and pharmacotherapy in academic psychiatric emergency services. General Hospital Psychiatry 26:42–49, 2004.PubMedCrossRef Allen MH, Currier GW: Use of restraints and pharmacotherapy in academic psychiatric emergency services. General Hospital Psychiatry 26:42–49, 2004.PubMedCrossRef
3.
go back to reference Weiss EM: Deadly Restraint: A Nationwide Pattern of Death. Hartford Courant. October 11, 1998. Weiss EM: Deadly Restraint: A Nationwide Pattern of Death. Hartford Courant. October 11, 1998.
4.
go back to reference US General Accounting Office: Mental Health: Improper Restraint or Seclusion Use Places People at Risk. GAO publication HEH-99–176. Washington, DC, USGAO, 1999. US General Accounting Office: Mental Health: Improper Restraint or Seclusion Use Places People at Risk. GAO publication HEH-99–176. Washington, DC, USGAO, 1999.
5.
go back to reference Mohr WK, Petti TA, Mohr BD: Adverse effects associated with physical restraint. Canadian Journal of Psychiatry 48:330–338, 2003. Mohr WK, Petti TA, Mohr BD: Adverse effects associated with physical restraint. Canadian Journal of Psychiatry 48:330–338, 2003.
6.
go back to reference Wynn R: Staff’s attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital. Nordic Journal of Psychiatry 57:453–500, 2003.PubMedCrossRef Wynn R: Staff’s attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital. Nordic Journal of Psychiatry 57:453–500, 2003.PubMedCrossRef
7.
go back to reference Evans D, Fitzgerald M: The experience of physical restraint: a systematic review of qualitative research. Contemporary Nurse 13:126–135, 2002.PubMed Evans D, Fitzgerald M: The experience of physical restraint: a systematic review of qualitative research. Contemporary Nurse 13:126–135, 2002.PubMed
8.
go back to reference Bonner G, Lowe T, Rawcliffe D, et al.: Trauma for all: A pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. Journal of Psychiatric Mental Health Nursing 9:465–473, 2002.CrossRef Bonner G, Lowe T, Rawcliffe D, et al.: Trauma for all: A pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. Journal of Psychiatric Mental Health Nursing 9:465–473, 2002.CrossRef
9.
go back to reference Wynn R: Psychiatric inpatients’ experiences with restraint. Journal of Forensic Psychiatry & Psychology 15:124–145, 2004.CrossRef Wynn R: Psychiatric inpatients’ experiences with restraint. Journal of Forensic Psychiatry & Psychology 15:124–145, 2004.CrossRef
10.
go back to reference Sequeira H, Halstead S: The psychological effects on nursing staff of administering physical restraint in a secure psychiatric hospital: “When I go home, it’s then that I think about it”. British Journal of Forensic Practice 6:3–15, 2004. Sequeira H, Halstead S: The psychological effects on nursing staff of administering physical restraint in a secure psychiatric hospital: “When I go home, it’s then that I think about it”. British Journal of Forensic Practice 6:3–15, 2004.
11.
go back to reference Busch AB, Shore MF: Seclusion and restraint: A review of the recent literature. Harvard Review of Psychiatry 8:261–270, 2000.PubMedCrossRef Busch AB, Shore MF: Seclusion and restraint: A review of the recent literature. Harvard Review of Psychiatry 8:261–270, 2000.PubMedCrossRef
12.
go back to reference Fisher WA: Restraint and seclusion: A review of the literature. American Journal of Psychiatry 151:1584–1591, 1994.PubMed Fisher WA: Restraint and seclusion: A review of the literature. American Journal of Psychiatry 151:1584–1591, 1994.PubMed
13.
go back to reference Morrison P, Lehane M: Staffing levels and seclusion use. Journal of Advanced Nursing 22:1193–1202, 1995.PubMedCrossRef Morrison P, Lehane M: Staffing levels and seclusion use. Journal of Advanced Nursing 22:1193–1202, 1995.PubMedCrossRef
14.
go back to reference de Cangas JPC: Nursing staff and unit characteristics: Do they affect the use of seclusion? Perspectives in Psychiatric Care 29:15–22, 1994.CrossRef de Cangas JPC: Nursing staff and unit characteristics: Do they affect the use of seclusion? Perspectives in Psychiatric Care 29:15–22, 1994.CrossRef
15.
go back to reference Betemps EJ, Somoza E, Buncher CR: Hospital characteristics, diagnoses, and staff reasons associated with use of seclusion and restraint. Hospital and Community Psychiatry 44:367–371, 1993.PubMed Betemps EJ, Somoza E, Buncher CR: Hospital characteristics, diagnoses, and staff reasons associated with use of seclusion and restraint. Hospital and Community Psychiatry 44:367–371, 1993.PubMed
16.
go back to reference Schwab PJ, Lahmeyer CB: The uses of seclusion on a general hospital psychiatric unit. Journal of Clinical Psychiatry 40:228–231, 1979.PubMed Schwab PJ, Lahmeyer CB: The uses of seclusion on a general hospital psychiatric unit. Journal of Clinical Psychiatry 40:228–231, 1979.PubMed
17.
go back to reference Brooks KL, Mulaik JS, Gilead MP, et al.: Patient overcrowding in psychiatric hospital units: Effects on seclusion and restraint. Administration and Policy in Mental Health 22:133–144, 1994.CrossRef Brooks KL, Mulaik JS, Gilead MP, et al.: Patient overcrowding in psychiatric hospital units: Effects on seclusion and restraint. Administration and Policy in Mental Health 22:133–144, 1994.CrossRef
18.
go back to reference Dietz PE, Rada RT: Seclusion rates and patient census in a maximum security hospital. Behavioral Sciences & the Law 1:89–93, 1983.CrossRef Dietz PE, Rada RT: Seclusion rates and patient census in a maximum security hospital. Behavioral Sciences & the Law 1:89–93, 1983.CrossRef
19.
go back to reference Kirkpatrick H: A descriptive study of seclusion: The unit environment, patient behavior, and nursing interventions. Archives of Psychiatric Nursing 3:3–9, 1989.PubMed Kirkpatrick H: A descriptive study of seclusion: The unit environment, patient behavior, and nursing interventions. Archives of Psychiatric Nursing 3:3–9, 1989.PubMed
20.
go back to reference Forquer SL, Earle KA, Way BB et al.: Predictors of the use of restraint and seclusion in public psychiatric hospitals. Administration and Policy in Mental Health 23:527–532, 1996.CrossRef Forquer SL, Earle KA, Way BB et al.: Predictors of the use of restraint and seclusion in public psychiatric hospitals. Administration and Policy in Mental Health 23:527–532, 1996.CrossRef
21.
go back to reference Tardiff K: Emergency control measures for psychiatric inpatients. Journal of Nervous and Mental Disease 169:614–618, 1981.PubMedCrossRef Tardiff K: Emergency control measures for psychiatric inpatients. Journal of Nervous and Mental Disease 169:614–618, 1981.PubMedCrossRef
22.
go back to reference Plutchik R, Karasu TB, Conte HR et al.: Toward a rationale for the seclusion process. Journal of Nervous and Mental Disease 166:571–579, 1978.PubMedCrossRef Plutchik R, Karasu TB, Conte HR et al.: Toward a rationale for the seclusion process. Journal of Nervous and Mental Disease 166:571–579, 1978.PubMedCrossRef
23.
go back to reference Soloff PH: Behavioral precipitants of restraint in the modern milieu. Comprehensive Psychiatry 19:179–184, 1978.PubMedCrossRef Soloff PH: Behavioral precipitants of restraint in the modern milieu. Comprehensive Psychiatry 19:179–184, 1978.PubMedCrossRef
24.
go back to reference Oldham JM, Russakoff LM, Prusnofsky L: Seclusion patterns and milieu. Journal of Nervous and Mental Disease 171:645–650, 1983.PubMedCrossRef Oldham JM, Russakoff LM, Prusnofsky L: Seclusion patterns and milieu. Journal of Nervous and Mental Disease 171:645–650, 1983.PubMedCrossRef
25.
go back to reference Gorsuch RL: Unimult for Univariate and Multivariate Analyses. Altadena, CA, Unimult, 1991. Gorsuch RL: Unimult for Univariate and Multivariate Analyses. Altadena, CA, Unimult, 1991.
Metadata
Title
Organizational and Unit Factors Contributing to Reduction in the Use of Seclusion and Restraint Procedures on an Acute Psychiatric Inpatient Unit
Authors
Richard Pollard, Ph.D.
Elisia V. Yanasak, Ph.D.
Steven A. Rogers, Ph.D.
André Tapp, M.D.
Publication date
01-03-2007
Publisher
Springer US
Published in
Psychiatric Quarterly / Issue 1/2007
Print ISSN: 0033-2720
Electronic ISSN: 1573-6709
DOI
https://doi.org/10.1007/s11126-006-9028-5

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