Abstract
Seclusion is a last resort intervention for management of aggressive behavior in psychiatric settings. There is no current objective and practical decision-making instrument for seclusion use on psychiatric wards. Our aim was to test the predictive and discriminatory characteristics of the East London Modified-Broset (ELMB), to delineate its decision-making profile for seclusion of adult psychiatric patients, and second to benchmark it against the psychometric properties of the Broset Violence Checklist (BVC). ELMB, an 8-item modified version of the 6-item BVC, was retrospectively employed to evaluate the seclusion decision-making process on two Psychiatric Intensive Care Units (patients n = 201; incidents n = 2,187). Data analyses were carried out using multivariate regression and Receiver Operating Characteristic (ROC) curves. Predictors of seclusion were: physical violence toward staff/patients OR = 24.2; non-compliance with PRN (pro re nata) medications OR = 9.8; and damage to hospital property OR = 2.9. ROC analyses indicated that ELMB was significantly more accurate that BVC, with higher sensitivity, specificity, and positive likelihood ratio. Results were similar across gender. The ELMB is a sensitive and specific instrument that can be used to guide the decision-making process when implementing seclusion.
Highlights
Reducing restrictive practice via the reduction of seclusion has become one of the top priorities of many health authorities [1,2,3]
Based on our clinical experience of Psychiatric Intensive Care Units (PICUs), and supported by evidence from the literature on seclusion, we extended on our previous exploratory work [39] on the development of a modified version of the Broset Violence Checklist (BVC), the East London Modified-Broset (ELMB), taking into consideration two factors affecting staff ’s seclusion decision-making when containing high acuity behaviors, that is, patient’s degree of compliance with PRN medications, per os (P.O.) or intramuscular (I.M.), and response to de-escalation or lack thereof
Chi-square analyses identified that individuals who were secluded were associated with a prior history of seclusion, χ2 (1, N = 168) = 5.61, p = 0.018, Cramer’s V: 0.17
Summary
Reducing restrictive practice via the reduction of seclusion has become one of the top priorities of many health authorities [1,2,3]. Implemented as a last resort treatment [10], at times alone, more often in combination with other, mainly pharmacological approaches [11, 12], seclusion use is criticized as an unjustifiable and potentially traumatic practice for patients [13,14,15,16,17]. These claims, remain hotly debated [18]. A lack of appropriate psychometric tools that standardize an objective seclusion
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