Implementation and Evaluation of Staff Debriefing After Seclusion and Restraint Events

Abstract

Problem and Purpose: Episodes of seclusion and restraint have recently increased by 380% from January-April 2021 compared to January-April 2020 in one adult Psychiatric Emergency Department in an academic medical center. Multiple factors contribute to this substantial increase in seclusion and restraint use; some factors are more amenable to practice change than others. The Psychiatric Emergency Department prioritizes patient safety and staff safety and aims to implement trauma-informed care. Evidence supports the importance of debriefing after a patient seclusion or restraint event to improve both patient and staff outcomes; however, staff debriefing is not currently practiced in the department. The purpose of this project is to implement staff debriefing after seclusion and restraint events in a Psychiatric Emergency Department. Methods: A quality improvement project was designed to implement a staff debriefing after patient seclusion and restraint events to assist in keeping staff and patients physically and psychologically safe. The goals of this project are to educate and train 100% of identified unit change champions on the debriefing process, debrief 100% of seclusion and restraint events on the unit during the implementation period and complete eight key debriefing components, and reduce seclusion and restraint events on the unit during the implementation period compared to the same timeframe in 2020 by 95%. Results: 100% of identified change champions were trained. The percentage of debriefings completed was 43%. The number of seclusion and restraint events rose by 126%. Conclusions: Reduction of seclusion and restraint events is multi-faceted and staff debriefing is a portion of the initiative and more time is needed to ensure implementation into unit culture and sustainability. The debriefing tool has been adopted for use throughout the organization’s Department of Psychiatry.