Implementation of Aggressive Behavior Management Intervention in Adult Psychiatric Inpatient Unit
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Abstract
Problem: The use of seclusion and restraints increases ligature risks in hospitals. An inpatient behavioral health unit's restraint and seclusion rate is 67.6%, higher than the national benchmark of 32%. Unit leaders report that seclusion and restraints are associated with staff turnover, callouts, and staff disability due to injury sustained while restraining patients with aggressive behavior. Purpose: This quality improvement project aimed to implement interventions using three selected domains of the evidence-based aggressive behavior management Safewards model to reduce seclusion and restraint rates and improve safety. Methods: Clinical nurses were educated about the Safewards model, and the domains selected for intervention, which included Regulatory Framework, Patient Community, and Physical Environment. These nurses served as champions on interdisciplinary teams to implement the three interventions: 1) obtaining a mutual safety agreement during the admission process, 2) collaborating with the treatment team to schedule family meetings for acceptable discharge planning, and 3) maintaining a safe physical environment by offering agitated patients a quiet or sensory room for de-escalation. Intervention implementation was monitored weekly by chart audit, and seclusion and restraint use were monitored monthly. Results: Of the 190 patients admitted during the project, 137 (72 %) patients signed mutual safety agreements, 190 (100%) family discharge planning meetings took place, and 57 (30 %) patients used the sensory or quiet room. Fifty-seven (30 %) patients required seclusion and restraints. Conclusion: Results demonstrate that implementing strategies aligned with the Safewards model may be associated with a decreased incidence of seclusion and restraint. This evidence-based project facilitated safety and care optimization in a behavioral health unit. Ongoing training is needed to facilitate the sustainability of the intervention.