Impact of a psychotropic medication and physical restraint review process on adults with mental retardation, psychiatric diagnoses, and challenging behaviors

Abstract

We examined the impact of a medication and physical restraint review process at an intermediate care facility for persons with mental retardation (ICF/MR) in Hawaii. The process was established in 1987 to review, approve, and monitor client programs that utilize medication, physical restraints, and time-out rooms to manage challenging behaviors, with a primary goal of establishing minimum effective use of restraints. Five variables were examined: (a) sample demographics; (b) psychotropic medication; (c) medication side effects; (d) physical restraints/time out; and (e) targeted behaviors. The study sample consisted of all current and former residents of the facility who participated in the review process and for whom an initial report and a follow-up report were available for examination (N=80). Results indicated a decrease in (a) the number of psychotropic medications prescribed, (b) reported medication side effects, and (c) frequency and duration of use of physical restraints/time out. There was an increase in the number of subjects for whom targeted challenging behaviors and behavioral counts were documented. In all behavioral categories except for physically aggressive behaviors, there was a decrease in the maximum number of incidents. In all behavioral categories, there was a decrease in the average number of incidents.