Developing a Multidisciplinary Care Bundle to Reduce the Use of Behavioral Restraints

background:In 2013, an 18-bed adult inpatient psychiatric unit performed worse than state norms in behavioral restraint incidence. Restraints are expensive and can re-traumatize patients and staff on the unit.  No psychiatric care bundles have been developed but literature review suggests that in an adult inpatient psychiatric setting a multi-pronged approach is most effective.

methods: The evidence-based practices in this care bundle include: Data Informing Practice;Crisis Prevention Tools;Trauma Informed Care;Sensory Grounding Techniques and Enhanced Patient Engagement. Staff were trained in the Plan Do Study Act (PDSA) model of CQI.

outcomes:  Decreased: assaults on staff; 1:1 sitter costs (60%);Patient complaints (36%);Restraint incidence. Increased: Group attendance (62%); Rank for “Likelihood of Recommending.”   

implications:  This care bundle produced positive clinical and business outcomes.  Use areas in other hospital units is likely.  The PDSA cycle is a useful tool for guiding change in an inpatient setting.

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LeBel, J, Goldstein, R, The Economic Cost of Using Restraint and the Value Added by Restraint Reduction or Elimination, Psychiatric Services, 2005. 56(9), 1109-1114.

Huckshorn, K.A., Reducing seclusion and restraint use in mental health settings. Journal of Psychosocial

and Mental Health Services, 2004. 42(9): p. 22-33.

Scanlan, J.N., Interventions To Reduce the Use of Seclusion and Restraint in Inpatient Psychiatric Settings: What We Know So Far a Review of the Literature. International Journal of Social Psychiatry, 2010. 56(4): p. 412-423.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Implementation of health education strategies, interventions and programs
Occupational health and safety
Program planning

Learning Objectives:
Describe a multidisciplinary care bundle for reduction in the use of behavioral restraints. Describe the Plan Do Study Act model to implement change in an inpatient unit. Demonstrate the business case for reduction in the use of behavioral restraints Define clinical case for restraint reduction

Keyword(s): Behavioral Research, Treatment Efficacy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I coordinated the project. I am an RN with a PhD in Social Policy with an interest in increasing patient and staff safety by reducing use of behavioral restraints. I have presented at the Massachusetts annual DMH conference on reduction of restraint and seclusion. A psychiatric department I directed received an annual award for Patient Safety.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3274.0: Designing Strength-Based Mental Health Services: Screening, Wellness Supports, Hospital and Continuum of Care