Reducing seclusion and restraints on the inpatient child and adolescent behavioral health unit: A quality improvement study.

BACKGROUND

The utilization of seclusion and restraint during psychiatric inpatient treatment increases the risk of trauma, humiliation, physical injuries, psychological distress, and even death. Compared to adult patients, pediatric patients are more likely to be placed in seclusion and restraints. In a short-term child and adolescent behavioral health unit, the average seclusion and restraint rate was 0.031. The hospital's goal was to achieve a zero seclusion and restraint rate.

PURPOSE

The purpose of this project was to decrease the rate of seclusion and restraints at the study site.

METHOD

A quality improvement study was implemented based on a bundled intervention strategy. The intervention included a decision-making algorithm for initiation of seclusion and restraints, behavioral modification plans for patients at risk of seclusion and restraints, and a patient-debriefing tool to be used post a seclusion and restraint event. Post implementation, data were collected over a 3-month period.

RESULTS

The implementation of a seclusion and restraint decision-making algorithm, behavioral modification, and patient debriefing successfully decreased the seclusion and restraint rate by 55% on an inpatient pediatric behavioral health unit.

CONCLUSION

Although, the project resulted in a successful reduction in the rates for seclusion and restraint, continued quality improvement efforts are indicated to achieve zero restraint/seclusions on the unit.