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Reducing Restraints and Injury Assaults in a Behavioral Health Setting
Challenging the status quo and creating a culture of innovation and change is essential to achieving positive patient outcomes. The goal of the presentation is to reveal strategies that unravel the believe that restraints are therapeutic and beneficial to patients in a behavioral health setting.
Significance:
Since 1999 there has been a nationwide initiative to reduce the use of seclusion and restraints in behavioral health settings. Evidence shows that restraint use had contributed to re-traumatization, injury, and patient death. Restraint reduction is imperative to the safety & well being of patients.
Strategy and Implementation:
Innovation at Sharp Mesa Vista Hospital began with nursing leadership support, creating a sense of urgency, willingness to take risks, and building upon the learnings that transpired during the practice change. The primary aim was to create a culture of safety that embraced restraint reduction and usage. The implementation process included a rigorous assessment of the current practice to identify barriers and trends. Secondly, a new crisis prevention training model was researched and deployed to all clinical employees. Thirdly, nursing leadership participated and supported employees during all critical escalating behavioural patient events. Fourthly, educational in-services were delivered by a clinical expert during an open forum setting. Lastly, consistent monitoring and evaluation of the new standard and protocol enabled the process to be embedded into everyday practice.
Evaluation:
The NDNQI quarterly data for physical restraints and injury assaults that occurred on the Child & Adolescent and Intensive Care Units revealed a 0% use of physical restraints for both units.Furthermore, injury assaults for the Child and Adolescent unit out surpassed the mean for comparative units.
Implications for Practice:
Reducing the use of physical restraints can protect the patient from trauma, harm, and injury. Deploying a solid plan,trusting in the process of change, having supportive nursing leadership,and analyzing the learnings are powerful tools of successful innovation.