title: Patterns of Restraint Utilization in a Community Hospital's Psychiatric Inpatient Units.
abstract: Restraint use in psychiatry has been a topic of clinical and ethical debate for years. As much as the medical community desires to attain the goal of a restraint-free environment, there are not many alternatives available when it comes to protecting the safety of violent patients and those around them. Our objective was to examine patterns of restraint use and analyze the factors leading to its use in adult psychiatric inpatient units. We conducted a retrospective review of restraint orders from January 2007 to December 2012, for inpatient units at a community mental health hospital, examining-unit, patient gender, number and duration of restraint episodes, time of day, and whether medications and/or verbal redirection were used. For the 6-year period studied, a total of 1753 restraint order-sheets were filed for 455 patients. Mixed-model regression found significant differences in duration of restraint episodes depending on: patient gender, unit, medication use, verbal redirection and AM/PM shifts. These differences were consistent over time with no significant interactions with years and remained significant when included together in an overall multivariate model. We elucidate variable patterns of restraint utilization correlating with elements such as patient gender, time of day and staff shift, medication use, and attempts at verbally redirecting the patient. Besides providing much needed data on the intricate dynamics influencing restraint use, we suggest steps to implement hospital-wide restraint-reduction initiatives including cultural changes related to restraint usage, enhanced staff-training in conflict de-escalation techniques and personalized treatment plans for foreseeable restraint episodes.
authors.affiliation: Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA. tjacob@maimonidesmed.org.
authors.forename: Theresa
authors.initials: T
authors.lastname: Jacob
authors.affiliation: Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Sahu
authors.affiliation: Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA.
authors.forename: Violina
authors.initials: V
authors.lastname: Frankel
authors.affiliation: Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.affiliation: Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Berman
authors.affiliation: Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA.
authors.forename: Scot
authors.initials: S
authors.lastname: McAfee
mesh_terms: D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006764:Hospitals, Community; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients; D008297:Male; D012044:Regression Analysis; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
keywords: Agitation; De-escalation; Inpatient unit; Physical restraints; Psychiatry