Impact of a mandatory behavioral consultation on seclusion/restraint utilization in a psychiatric hospital

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Abstract

Despite demonstrations of the utility and cost effectiveness of behavioral methods for improving care for people with psychiatric impairments, they are seldom employed effectively in inpatient settings. This study evaluated the impact of an administrative procedure to effect a behavioral consultation for cases of high seclusion\restraint utilization. Seclusion\restraint use for the 53 cases was reviewed for a time period of 6 months before and 6 months after development of a behavioral treatment plan resulting from this procedure. The data revealed a 62% reduction in seclusion\restraint use after development of an approved plan. There was also a reversal in serial trend from increasing use during the months prior to plan development to decreasing use during months after plan development. The procedure is described and implications of the results for clinicians and administrators of psychiatric inpatient programs are discussed.

Section snippets

Procedure

This procedure was instigated after concerns were expressed by members of a local Human Rights Committee which serves as an external review authority for various patients’ rights issues encountered in the psychiatric inpatient setting. The committee became concerned by the number of hospital residents whose treatment plans referenced the use of seclusion or restraint and which, by policy, required their review and sanction. They requested that a consultation procedure be established to realize

Results

At any time, approximately 10% of the hospital’s residents will have a plan which has required review and approval by the BMC. Seclusion\restraint utilization for 53 residents who currently have an approved plan is summarized in Fig. 1. Each of these residents had been referred because they had exceeded the monthly criterion. These data include residents who required a BMC reviewed plan and for whom there were 6 months of data before and 6 months of data after approval of the treatment plan. Of

Discussion

The analysis of these data highlights several points which are relevant to improving care in an inpatient psychiatric setting. First, the data provide additional support for the effectiveness of behavioral methods for ameliorating problems encountered by caregivers of people with severe and persistent psychiatric impairments. The residents identified by the seclusion\restraint monitoring procedure were among the most difficult-to-manage individuals in the hospital. Previous reports which

Acknowledgements

The author acknowledges the efforts of the members of Western State Hospital’s Behavior Management Committee in making this manuscript possible. I wish to express my appreciation to: Michael Bowermaster, Ph.D., Vernon Browning, M.ED., Brenda Franklin, M.S.W., Gerald McKeegan, Ph.D., Jeffrey Phillips, Ph.D., David Rawls, Ph.D., Margaret Turner, M.S.N., and Randolph Urgo, J.D..

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