Poster Presentation

Friday, July 13, 2007
9:30 AM - 10:15 AM

Friday, July 13, 2007
3:15 PM - 4:00 PM
This presentation is part of : Poster Presentation III
Restraint And Seclusion Reduction In AChild Psychiatric Unit
Evelyn A. Petralia, MS, RN, Nursing, Stony Brook University Medical Center, Stony Brook, NY, USA
Learning Objective #1: identify methods for seclusion and restraint reduction.
Learning Objective #2: successfully use alternative methods, rather than seclusion or restraint.

When children on the Child Psychiatric unit became angry, agitated and out of control, the method of containment had been Seclusion or Restraint.  The volume of Seclusion and Restraint soared to over 400 episodes in 1999.  An Interdisciplinary Treatment Team explored alternatives to this method of control.

 In December of 1999, the use of PRN Benadryl was implemented to provide symptomatic relief to the child and allow him/her to regain control.  In 2000, the Behavior Management Program added the use of a “quiet room,” in addition to medication.  The result was a 50% reduction in the use of Seclusion and Restraint.

            During this time, staff continued to receive training and education supporting repeated de-escalation techniques as alternatives to the use of seclusion and restraint.  The outcome of these measures sustained the 50% reduction in 2001.

            Seclusion and Restraint results for 2002 saw an additional 50% reduction from the previous year.

            In 2003, through a collaborative effort of Medicine and Nursing, an “agitation scale” was developed.  This tool brought consistency to the evaluation process when a child was to receive medication.  The outcome was Seclusion and Restraint plummeted another 50%, fewer than 50 incidents.  The number of occurrences in 2004 was a 94% decline from 1999.  2005 episodes saw another 50% reduction and 2006 evidenced a further decline.

            This unremitting plunge in the use of Seclusion and Restraint also reveals improved patient safety and staff safety.  There have been no incidents of patient or staff injury during restraint for the past three years.  This model has afforded a procedure and culture change that is best practice for the patient and team.