Transition to a Restraint-Free Inpatient Behavioral Health Setting

Abstract

Background The use of restrictive interventions, such as mechanical restraints, has been a common practice in behavioral health settings since the field’s early infancy. The use of restraints has a harmful impact on both patients and providers alike, contraindicating the therapeutic treatment environment aimed to support the healing journey. Using a strategy of leadership, workplace development, and data, the use of mechanical restraints was fully eliminated from a 252-bed inpatient setting. Performance was sustained over the following year. Objectives The goal of this project was to fully eliminate the use of mechanical restraints in an inpatient behavioral health setting. Adopting the Six Core Strategies for Reducing Seclusion and Restraint Use, the hospital sought to provide staff with alternative tools supported by an evidence-based practice. The result would be a reduction of trauma and injury occurring during the restraint process. Methods This quality improvement project identified processes, structures, and patient outcomes related to restraint reduction within the organization. Each opportunity for improvement included a needs assessment for the identified barriers. The action steps necessary to implement change and accomplish the goal of reducing the use of four-point mechanical restraints in hospitalized patients were guided by trauma-informed care and the Six Core Strategies, in turn decreasing physical and psychological injuries, and improving patient care. Results Progress toward zero mechanical restraints was incremental. Both qualitative and quantitative data were used on a daily basis to support staff interventions. Active investment from leadership and allied professions provided support for a culture shift that went from using mechanical restraint almost daily to a culture where mechanical restraint is seen as a failure. This success was sustained through 2022 and is now a standard expectation for care at Belmont. This project enabled the removal of mechanical restraints from an acute inpatient behavioral health hospital servicing children, adolescents, and adults. The factors that supported the success of this project were true endorsement from leadership, robust staff training, and continuous feedback and supervision. Sustainability over at least one year was achieved. Conclusions Belmont is not the first inpatient setting to eliminate restraints for its programming; however, this project provides additional evidence that a restraint-free inpatient setting is possible with sufficient investment in staff and training. Using trauma-free interventions was an additional quality benefit that has enhanced the advantages of the way this program was designed. The implementation of this model and supporting interventions can provide a roadmap for other programs seeking to enhance the inpatient experience for both staff and patients.