After a training program and policy changes, a 398-bed state psychiatric hospital in North Carolina achieved 98% and 100% reductions in the use of mechanical restraints in its two main units over three years, according to a study published in Psychiatric Services. At the same time, there were no increases in assaults or injuries to staff or patients.
Led by Central Regional Hospital psychologists, the study took place between 2009-12 on a 140-bed acute adult unit (AAU) and a 76-bed community transition unit (CTU) holding patients diagnosed with schizophrenia-spectrum disorders, mood disorders, and substance use disorders. All staff were trained in basic de-escalation techniques, and a special response team was trained and formed to assist in crisis situations. Secondly, a formal policy change was introduced that required upper-management approval for staff to implement routine use of restraints on a patient.
“Mechanical restraint use decreased by 98% on AAU and by 100% on CTU,” the researchers wrote. “At the end of the study, CTU had not used the intervention in 559 days… These strategies were implemented during the study but have become part of the culture and the hospital’s standard operating procedure and have continued beyond the study.”
At the same time, there was no increase in physical violence in the units. “It is important to note that the reduction in mechanical restraint use on both units occurred without increased rates of assaults or injuries to consumers or staff,” wrote the researchers. Simultaneously, the use of “as-needed” or PRN medications for reducing agitation decreased on one of the units; however, for unknown reasons usage increased on the other unit. “It is unclear why PRN use of medications significantly increased on CTU but not on AAU,” wrote the reseachers. “Further investigation of factors that influence prescribing and administering PRN medications seems warranted.”
“The success of this initiative demonstrated that reduction and even elimination of mechanical restraint can be accomplished in a state psychiatric hospital on both acute and rehabilitation units without increasing assaults and injuries to consumers or staff,” the researchers concluded. They also noted that “committed leadership was essential” for implementing the changes. “Recovery-oriented, strong leaders were champions for the initiative.”
Anatomy of a Transformation: A Systematic Effort to Reduce Mechanical Restraints at a State Psychiatric Hospital (Godfrey, Jenna L. et al. Psychiatric Services. Published Online Ahead of Print August 15, 2014. doi: 10.1176/appi.ps.201300247)