Almost one in four patients in psychiatric hospitals in Ontario, Canada between 2006 and 2010 were subjected to “control interventions” such as chairs that prevent rising, wrist restraints, seclusion rooms, or “acute control medications,” reported a study published in Healthcare Management Forum.
University of Waterloo researchers looked at records for 115,384 admissions from 72 hospitals throughout the province of Ontario. They found that 24% or 27,171 patients experienced at least one form of control intervention. The most frequently used method was acute control medication with 19% or 21,422 events, followed by mechanical or physical restraints in 7% of cases or 7,476 events, and seclusion in 6% or 6,544 cases. Chairs that prevent people from getting up were used 1,068 times. The researchers also found that the rates of use of control intervention methods overall, and in the particular forms, varied greatly from one region of the province to another.
“The latest findings show that the use of restraints and medications as control interventions is still an everyday practice in inpatient mental health units,” said study co-author John Hirdes in a press release.
Lead author Tina Mah commented that, “Control interventions are not ideal because they counter a patient-centered approach to care and can damage therapeutic relationships while further stigmatizing patients.”
In the limitations section of their study, they suggested that their findings likely underestimated the actual prevalence rates of use of control interventions, because the way the data was recorded really provided only three-day snapshots at any time. Elsewhere, they also indicated that they had not included uses of “PRN” or “as needed” medications that were identified as part of patients’ treatment plans. However, physicians sometimes prescribe PRN drugs for nurses to give to patients for control interventions.
They wrote in their conclusions: “The time is now for healthcare leaders to be aware of the quantitative evidence pointing to the unacceptably high rates of CI (control intervention) use in Ontario hospitals, to clearly articulate this burning platform, and to call to action those who can make an impactful change to improve the safety of care for adult in-patient MH (mental health) services. One way forward to improvement is to publicly report CI use not as a punitive act but an act of transparency in accountability for patient safety to create motivation through attention. Rates of CI use are not uniform across Ontario, therefore understanding regional differences will be an important consideration when identifying potential CI reduction strategies.”
Mah, Tina M., John P. Hirdes, George Heckman, and Paul Stolee. “Use of Control Interventions in Adult in-Patient Mental Health Services.” Healthcare Management Forum 28, no. 4 (July 1, 2015): 139–45. doi:10.1177/0840470415581230. (Abstract)
Restraint, confinement still an everyday practice in mental health settings (University of Waterloo press release on ScienceDaily, July 6, 2015)