Journal of Behavior Therapy and Experimental Psychiatry
Impact of a mandatory behavioral consultation on seclusion/restraint utilization in a psychiatric hospital
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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2014, General Hospital PsychiatryCitation Excerpt :While their generalizability outside the PES may be limited, we wonder if these findings might help risk stratify some patients in general emergency departments, for example, in discerning allocation of limited seclusion rooms [26,27]. Moreover, in proffering a clinical portrait of patients more likely to experience restraint or seclusion in the PES, this research can help translate previously described approaches for reducing restraint/seclusion to the PES through adoption of policy and quality improvement initiatives [28–31], staff training [32,33] and findings from randomized controlled trials [34–36]. This work demonstrates opportunities for prospective studies of risk stratification and treatment approaches in the psychiatric emergency setting.
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