Anatomy of a transformation: a systematic effort to reduce mechanical restraints at a state psychiatric hospital.

Abstract

The authors describe efforts to reduce use of mechanical restraints at a state psychiatric hospital. Data were collected for individuals admitted to the acute adult unit (AAU) (N=2,910) and the community transition unit (CTU) (N=334) over three years. Two strategies aimed to reduce mechanical restraint use. First, staff were trained in deescalation techniques, and a response team was formed for crisis situations. Second, a policy change required prior approval for use of mechanical restraint. Mechanical restraint was significantly reduced on both units after the first strategy. After the second, additional reduction was noted on AAU (98% total reduction) but not on CTU, where the practice had already been eliminated. No increase in assaults or injuries was noted. Reduction in mechanical restraint use is possible through deescalation skills training, use of a response team, and policy changes. Strong leadership, staff buy-in, provision of feedback, and quality monitoring were also instrumental.