title: Reducing restraint use in a public psychiatric inpatient service.
abstract: The use of behavioral restraint in psychiatric inpatients can have physically and emotionally damaging effects. However, staff may view the use of restraint as a routine and acceptable means of maintaining safety. The goal of this project was to reduce the use of restraint in a public psychiatric inpatient service that serves an economically disadvantaged urban population. Six interventions that primarily involved changing staff behavior were made to reduce the use of restraint. These included better identification of restraint-prone patients, a stress/anger management group for patients, staff training on crisis intervention, development of a crisis response team, daily review of all restraints, and an incentive system for the staff. The rate of restraint use (number of restraints/1000 patient-days) during the 3 years before the interventions was compared with the rate during the 2 years after the interventions. There was a significant decrease in the rate of restraint use after the restraint reduction initiatives were implemented. The reduction was not accompanied by a sustained increase in incidents of assault, suicidal behavior, or self-injury.
authors.affiliation: Woodhull Medical and Mental Health Center, 760 Broadway, Brooklyn, NY 11206, USA. mccuer@nychhc.org
authors.forename: Robert E
authors.initials: RE
authors.lastname: McCue
authors.forename: Leonel
authors.initials: L
authors.lastname: Urcuyo
authors.forename: Yehezkel
authors.initials: Y
authors.lastname: Lilu
authors.forename: Teresa
authors.initials: T
authors.lastname: Tobias
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Chambers
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006778:Hospitals, Psychiatric / Q000592:standards*; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D009042:Motivation; D016134:Organizational Policy; D010348:Patient Care Team / Q000592:standards*; D017064:Process Assessment, Health Care; D011369:Professional-Patient Relations; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D016728:Self-Injurious Behavior; D013406:Suicide, Attempted; D035862:Vulnerable Populations / Q000523:psychology