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Implementation of the Safewards Model to Reduce Inpatient Seclusion and Restraint Episodes

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Sullivan, Jessica
Date
2025-05
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DNP Project
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Problem: Seclusion and restraint episodes increase the risk of workplace violence, staff injuries, staff turnover, patient injuries, and legal consequences for the hospital. A twelve-bed behavioral health unit did not meet the hospital target goal of 0.012% for seclusion episodes per patient days, and the rate increased from 0.211% to 0.352% between October 2023 to January 2024. Purpose: The purpose of this quality improvement project was to reduce seclusion and restraint episodes among adult psychiatric patients aged 18 to 65 at a medium-sized community hospital in Maryland by implementing and measuring adherence to the Safewards Model, an evidence- based practice change. Methods: A quality improvement project implementing the Safewards Model occurred over a 15-week period between August to December 2024. Each of the ten Safewards Model interventions were integrated into unit workflow changes, measured (0-10 scale), and calculated for overall adherence to the model (0-100). Data was collected with the Chart Audit tool completed by the QI-Project Lead weekly, and the Nurse Shift Report Audit tool completed by the Charge nurse every shift. Weekly data analysis was guided by run charts to promote adherence and sustain process changes. Results: The overall adherence to the Safewards model was 68.4%. The Nurse Shift Report Audits were completed on 68.0% of shifts (n=136/200 total shifts). There were nine episodes of physical holds, with an average length of three minutes. There were five episodes of seclusion, with an average length of 116.8 minutes. There were no episodes of restraint use. Conclusions: Project findings can be used in practice to promote a more therapeutic and safe work environment for nurses and patients. The Safewards model was feasible to integrate into the current workflow. More extensive education and a longer implementation period would likely improve nursing adherence to this model.

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