title: Impact of the creation and implementation of a clinical management guideline for personality disorders in reducing use of mechanical restraints in a psychiatric inpatient unit.
abstract: OBJECTIVE
  To evaluate the impact of the implementation of a guideline for the management of personality disorders on reducing the frequency of use of mechanical restraints in a psychiatric inpatient unit.
  
  
  METHODS
  This retrospective study was conducted in a psychiatric inpatient unit with 42 beds, which serves an urban area of 330,000 inhabitants. The sample consisted of all patients with a clinical diagnosis of personality disorder (DSM-IV-TR criteria) who were admitted to the unit from January 2010 to December 2010 and from January 2011 to December 2011 (ie, before and after, respectively, the implementation of the guideline). The guideline focused on cluster B disorders and follows a psychodynamic perspective.
  
  
  RESULTS
  Restraint use was reduced from 38 of 87 patients with personality disorders (43.7%) to 3 of 112 (2.7%), for a relative risk of 0.06 (95% CI, 0.02-0.19) and an absolute risk reduction of 41% (95% CI, 29.9%-51.6%). The risk of being discharged against medical advice increased after the intervention, with a relative risk of 1.84 (95% CI, 0.96-3.51). Restraint use in patients with other diagnoses was also reduced to a similar extent.
  
  
  CONCLUSIONS
  The use of mechanical restraints was dramatically reduced after the implementation of a clinical practice guideline on personality disorders, suggesting that these coercive measures might be decreased in psychiatric inpatient units.
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gonzalez-Torres
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Aranzazu
authors.initials: A
authors.lastname: Fernandez-Rivas
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Sonia
authors.initials: S
authors.lastname: Bustamante
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Fernando
authors.initials: F
authors.lastname: Rico-Vilademoros
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Esther
authors.initials: E
authors.lastname: Vivanco
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Karmele
authors.initials: K
authors.lastname: Martinez
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Miguel
authors.initials: M
authors.lastname: Angel Vecino
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Melba
authors.initials: M
authors.lastname: Martín
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Sonia
authors.initials: S
authors.lastname: Herrera
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Jorge
authors.initials: J
authors.lastname: Rodriguez
authors.affiliation: Department of Neuroscience, University of the Basque Country, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante); Psychiatry Service, Basurto University Hospital, Bilbao, Spain (Drs Gonzalez-Torres, Fernandez-Rivas, and Bustamante; Mss Vivanco, Martinez, Martín, and Herrera; and Mssrs Vecino, Rodriguez, and Saenz); and Neuroscience Institute, Granada University, Granada, Spain (Dr Rico-Vilademoros).
authors.forename: Carlos
authors.initials: C
authors.lastname: Saenz
references.citation: J Pers Disord. 2013 Apr;27(2):222-32
references.pmid: 23514185
references.citation: Int J Law Psychiatry. 2008 Jan-Feb;31(1):72-6
references.pmid: 18191455
references.citation: Worldviews Evid Based Nurs. 2006;3(1):8-18
references.pmid: 17040518
references.citation: BMC Psychiatry. 2012 May 30;12:54
references.pmid: 22647058
references.citation: Psychiatr Serv. 2010 Oct;61(10 ):1012-7
references.pmid: 20889640
references.citation: Psychiatr Serv. 2011 May;62(5):492-7
references.pmid: 21532074
references.citation: Clin Pract Epidemiol Ment Health. 2008 Nov 17;4:27
references.pmid: 19014698
references.citation: Br J Psychiatry. 2008 Jul;193(1):44-50
references.pmid: 18700217
references.citation: J Korean Acad Nurs. 2012 Dec;42(7):1062-9
references.pmid: 23377602
references.citation: Perspect Psychiatr Care. 2012 Apr;48(2):83-94
references.pmid: 21967236
references.citation: Psychiatr Serv. 2006 Aug;57(8):1192-8
references.pmid: 16870972
references.citation: Int J Law Psychiatry. 2011 Nov-Dec;34(6):429-38
references.pmid: 22079087
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2010 Sep;45(9):889-97
references.pmid: 19727530
references.citation: Clin Trials. 2008;5(4):356-63
references.pmid: 18697850
references.citation: Nord J Psychiatry. 2014 Oct;68(7):443-9
references.pmid: 24274836
references.citation: Br J Psychiatry. 2007 Oct;191:298-303
references.pmid: 17906239