Use of restrictive interventions in a child and adolescent inpatient unit - predictors of use and effect on patient outcomes.
OBJECTIVE
Restrictive interventions (seclusion, physical restraint, and use of acute/p.r.n. sedation) may have negative effects on patients. Identifying factors associated with use of restrictive interventions and examining their effect on admission outcomes is important for optimising inpatient psychiatric care.


METHODS
This study documented use of restrictive interventions within a child and adolescent psychiatric inpatient unit for 15 months. Two models examined predictors of use of restrictive interventions: (i) incident characteristics; and (ii) patient characteristics. The relationship between use of restrictive interventions and global clinical outcomes was also examined.


RESULTS
Of 134 patients admitted during the study period (61.9% female, mean age=13.8±2.9 years), 26.9% received at least one restrictive intervention. Incident factors associated with restrictive interventions were: physical aggression, early admission stage, and occurrence in private space. Patient factors that predicted use of restrictive interventions were developmental disorder and younger age. Use of restrictive interventions was not associated with increased length of stay or diminished improvement in global symptom ratings.


CONCLUSIONS
Further research is needed to identify best practice in children at high risk for receiving restrictive interventions.
Kids in Mind Research, Mater Research, Mater Health Services, South Brisbane, QLD, Australia.
Suzanne G
SG
Duke
Kids in Mind Research, Mater Research, Mater Health Services, South Brisbane, QLD and; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston QLD and; Discipline of Psychiatry, The University of Queensland Centre for Clinical Research, Herston QLD, Australia.
James
J
Scott
Kids in Mind Research, Mater Research, Mater Health Services, South Brisbane, QLD 4101 Australia, School of Medicine, The University of Queensland, Herston, QLD, Australia a.dean@uq.edu.au.
Angela J
AJ
Dean
aggression; developmental disorders; mental health inpatient units; restraint; seclusion