The Commonwealth of Pennsylvania’s Office of Mental Health and Substance Abuse Services (OMHSAS) identified seclusion and restraint as practices that are associated with significant risk to the patient and to the staff in the state hospitals. No longer considered acceptable or compatible with best practice, alternatives to the use of these restrictive interventions were encouraged. Strict guidelines for the use of seclusion and restraint were developed to assure patient safety and to assure that neither would be used unless all reasonable alternatives had been exhausted. Additionally, the guidelines required the attending physician to perform an on-site assessment of the patient concurrent with the use of these restrictive measures in order to assure that the patient was not being physically compromised and to assure that alternative measures were being continuously pursued. Prior to the issuance of the guidelines, the incidence and duration of episodes of seclusion and restraint were used as benchmark measures of performance among the State hospitals; this data was used to meet the ORYX requirements of JCAHO. This identification of seclusion and restraint as high-risk interventions and the encouraged use of alternatives caused a decline in the incidence and duration of seclusion and restraint from the initiation of the process in 1997. With adoption of the guidelines in January of 1999, the rate of decline accelerated.
Since 1997, combined incidents of seclusion and restraint have been reduced by 74%, while hours of use have decreased by 96%. One hospital has been virtually seclusion and restraint free for over one year.
Learning Objectives: 1. Establishing a mandate in your health care system to ruduce the use of seclusion and restraint. 2. Develop a performance improvement system to monitor your objectives. Educating your staff on how to accomplish reduction of seclusion and restraint. 3. How to use continuous quality improvement processes to improve staff and patient safety.
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Pa. State Mental Hospital System
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.