Restraint Reduction at a Pediatric Psychiatric Hospital: A Ten-Year Journey.

BACKGROUND

Restraints are used as one of the safety interventions for children and adolescents in various community, hospital, and treatment settings. Although considered safety interventions, restraints are known to have many adverse effects on children and staff, including injuries; even reports of death are noted in the literature.

OBJECTIVE

In an effort to reduce the use of restraints and to provide trauma-informed care in a 52-bed Pediatric Psychiatric Hospital, a quality improvement project was launched.

INTERVENTIONS

Primary prevention principles based on trauma-informed and strength-based care were utilized to provide care for children and adolescents. Hospital leadership played an instrumental role in bringing positive culture change. Staff involvement and training in restraint reduction and prevention tools played a key role in this project. Debriefing and problem solving were effective interventions for the prevention of restraints. Involvement of youth and family in treatment planning built stronger relationships with staff and paved the way for better communication and trust, and improved understanding of strengths and needs of children and adolescents.

RESULTS

Over a 10-year period, mechanical restraints decreased by 100%, from 485 in 2005 to "zero" in 2014 and none in the last 3 years. Physical restraints decreased by 88%, from 3,033 in 2005 to 379 in 2014.