Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA.
J Am Acad Psychiatry Law. 2011;39(4):465-76.
Changing federal regulations, civil rights and malpractice cases, and new treatment methods have influenced the use of restraint and seclusion (R&S) in inpatient psychiatric treatment settings, such that restraint and seclusion today are among the most highly regulated practices in psychiatry. Despite increased pressure from regulatory bodies and litigation, the use of R&S remains controversial and risky. These procedures can compromise safety if performed incorrectly or monitored inadequately, but intervention by restraint or seclusion may be necessary to maintain safety on the treatment unit, especially during emergencies. Case law and medical research have demonstrated the importance of a patient-focused, treatment-oriented approach toward risk management. Analysis of specific clinical scenarios can help to develop risk mitigation strategies that are therapeutically conceptualized rather than driven by regulation. Insights drawn from clinical cases that have resulted in litigation can offer an opportunity to develop an approach oriented to patient care from a clinical or risk management perspective. In this article, we seek to provide a foundation for evaluation of current protocols, an analysis of adverse R&S events, and strategies to minimize risk.
联邦法规的变化、民权和医疗事故案件，以及新的治疗方法都影响了住院精神病治疗环境中约束和隔离（R＆S）的使用，以至于如今约束和隔离成为精神病学中受到高度监管的治疗方法之一。尽管监管机构和诉讼的压力不断增加，但 R＆S 的使用仍然存在争议和风险。如果操作不当或监测不足，这些程序可能会危及安全，但为了在治疗单元上保持安全，特别是在紧急情况下，可能需要进行约束或隔离干预。判例法和医学研究表明，针对风险管理采取以患者为中心、以治疗为导向的方法非常重要。对特定临床情况的分析有助于制定治疗性概念化的风险缓解策略，而不是受法规驱动。从导致诉讼的临床案例中汲取的经验教训为从临床或风险管理的角度为患者护理制定方法提供了机会。在本文中，我们旨在为评估当前方案、分析不利的 R＆S 事件以及最小化风险的策略提供基础。
