Decreasing the Rate of Seclusion and Restraint Using the Six Core Strategies

Abstract

Problem: Seclusion and restraint can cause physical injury and psychological harm to both patients and staff, as well as contribute to traumatization of patients. The national average for restraint rate is 0.39 hours per 1,000 patient hours. In March 2022, the project site’s restraint rate was 0.8619 per 1,000 patient hours. From April 2021-March 2022, the project site had only three months where the restraint rate was within 5% variance of the Centers for Medicare and Medicaid Services (CMS) average. Purpose: The purpose of this quality-improvement initiative is to implement a Six-Core Strategy program to modify staff-patient communication and deescalation strategies with the overall goal of reducing seclusion and restraint use on a mixed disorders adult inpatient psychiatric unit. Methods: The initiative will be implemented over a 15-week period in the fall of 2023. This project will measure the rate of project attendance based on rotating schedule established with project unit manager. The rate of project attendance will be measured by dividing the number of actual program attendees by the number of staff members who were scheduled to participate in each week. The rate of seclusion and restraint will be measured using HBIPS-2 and HBIPS-3 reporting criteria to compare the 15 weeks prior to implementation to the 15 weeks following. Results: The project achieved 100% participation during weeks 1, 4, 7, 10, and 12-15. The majority of staff attended program meetings. HBIPS-2 (90.4%) and HBIPS-3 (37.4%) scores decreased in the 15 weeks after project initiation compared to the 15 weeks prior. Conclusions: A major barrier to implementation is ensuring nursing staff participation, as there are competing demands for patient care. Many staff members would rather be available to their patients than taken away from direct patient care. Staff members that attended reported finding the training useful and worthwhile.