Implementation of Immediate Staff Debrief Tool after Seclusion and/or Restraint Use

Abstract

Problem: In an adult psychiatric inpatient unit at a tertiary-care academic hospital, there was a 381% increase in total seclusion and restraint rate over a three-month period in 2021. The inpatient psychiatric unit inconsistently conducted staff debriefing due to its lack of staff education, monitoring, and documentation of the debriefing process. Literature found that the implementation of a staff debriefing tool reduces the negative consequences of seclusion and restraint use and promotes reflective practice and therapeutic relationships. Purpose: The purpose of this Quality Improvement project is to improve staff debriefing practice and to decrease the total seclusion and restraint rate in an adult psychiatric inpatient unit at a tertiary-care academic hospital by implementing a staff debrief tool following seclusion and/or restraint use. Methods: This 15-week project was implemented in the fall of 2022. In-person educational sessions were provided, and the completion rate of the debrief tool was measured. The total seclusion and restraint rate was tracked via the organization’s Electronic Health Record system. The unit champions promoted the project and provided additional feedback and education. Results: All nurses received an in-person education, and the median debrief tool completion rate was 100%. A special-cause pattern was noted in the first 9-weeks of the implementation. However, the total seclusion and restraint rate increased by 41% when pre- and post-implementation periods were compared. Conclusions: Findings highlighted the feasibility of this practice change within the setting and the confounding variables that affected the immediate staff debrief tool’s ability to reduce total seclusion and restraint rate. Implementing a staff debrief tool can improve staff debriefing practice by ensuring education, documentation, and monitoring of the debriefing process after seclusion and/or restraint use.