Use Of Restrictive Procedures Research Articles

Preventing COVID-19 in assisted living facilities: An impossible task pending vaccination roll out.

Here, we aimed to describe the clinical outcomes of the residents of a long-term care facility during its closure to visitors and suppliers in response to the first COVID-19 pandemic from February 23 to June 22, 2020, and the results of the facility-wide SARS-CoV-2 testing of residents and staff in June 2020 before its partially reopening. Seventy-four residents and 53 members of staff were included in the present study. The staff underwent nasopharyngeal swab tests for SARS-CoV-2, and both the staff and residents underwent serological tests to detect IgG antibodies against SARS-CoV-2. The results of all of the tests were negative. Conversely, 94% of residents and 38% members of the staff were tested positive to the nasopharyngeal swab tests during the second COVID-19 pandemic wave (data collected from November 1 to November 30, 2020). Our experience suggests that, in the presence of a life-threatening pandemic such as SARS-CoV-2 infection, the prompt use of restrictive procedures can prevent the spread and progression of disease in assisted living facilities in the short term but may fail in the long term, especially when the prevalence of the COVID-19 greatly increased outside the facility enhancing the risk of import the disease from outside. SARS-CoV-2 vaccination of residents and staff members would contribute to control/limit the prevalence and the spread of the virus.

Nurses’ opinions regarding patient safety in connection with the use of restraints in patients in Czech hospitals

This research survey was aimed at identifying the opinions of nurses regarding the issue of patient safety in the use of restraints on patients in hospitals in the Czech Republic. The research was designed as a sociological study and was accomplished through the technique of a questionnaire survey using an interviewer. The sample group of nurses included nurses working in shifts on the hospital wards and was based on the needs of the project and the methodology of the Institute of Health Information and Statistics of the Czech Republic. The entire sample consisted of 772 nurses. Most nurses considered the likelihood of an injury to the patient in the use of means of restraint (specifically when strapping the patient) to be negligible (48%) and low (36.9%). Nurses working in surgical and medical wards reported a higher likelihood of patient injuries during restriction while bedridden than nurses working in other departments. The existence of a standard or regulation that would regulate the procedure for the use of restraints, if a patient is restless, aggressive or at risk of self-harm was confirmed by 91.3% of nurses. Immobilization and restraint in justifiable cases in surgeries are carried out by 65.5% of nurses. To prevent complications connected with the use of restraints, we consider continual training sessions and education of medical personnel important in connection with the use of restraints and auditing in maintaining standards of nursing care and the prevention of complications associated with the use of restrictive procedures, and then using these measures only in necessary and justified cases.

An Analysis of the Distribution and Social Antecedents of Restrictive Behavioural Practices in a Community Day Service for Adults with Intellectual Disabilities

Background Community service providers strive to reduce the use of restrictive behavioural procedures, but little is known about their use in community services. Therefore, this study analysed the distribution among service users and antecedents to the use of restrictive procedures.Materials The authors analysed records of the use of restrictive behavioural procedures for 81 adults with intellectual disabilities, behavioural and mental health challenges who attended a community day programme. The authors obtained data from one quarter in each of three consecutive years. The authors analysed the frequency of restrictive procedures by individual and the frequency of antecedents to the use of restrictive procedures.Results A small proportion of service users accounted for all use of restrictive procedures. This was true for all three data sets. We coded antecedents to the use of restrictive procedures reliably. The most common antecedents were transitions and seatwork.Conclusion Restrictive behavioural procedures are concentrated among a small proportion of service users and occasions. Efforts to reduce the use of restrictive procedures should first identify these service users and occasions and then focus efforts to reduce restrictive procedures there. Information concerning the antecedents of restrictive behavioural procedures may be useful as part of a descriptive assessment to design individual interventions to reduce restrictive procedures.

Clinical Psychopathology, Untoward Incidents and the Use of Restrictive Procedures in Adults with Intellectual Disability

Background Previous evidence has suggested that clinical characteristics may predict use of restraint in adults with intellectual disability. However, the relationship between specific types of untoward incidents, corresponding interventions (restrictive procedures) and clinical psychopathology remains unclear.Method We examined all untoward incidents (n = 397) that were recorded for a group of service users (n = 65) referred to a specialist unit for adults with intellectual disability over a 6‐year period. Associations between different restrictive procedures and clinical psychopathology were investigated.Results Physical assault was the most common incident associated with physical restraint, male gender and presence of autism. De‐escalation was the most frequently employed intervention associated with less serious incidents such as verbal abuse and theft.Conclusions Specific interventions seem to be associated with different types of incidents and presence of autism. The results are discussed in terms of clinical practice and possible future directions.

Predictors of Restrictive Reactive Strategy Use in People with Challenging Behaviour

Background Intrusive reactive strategies (physical restraint, emergency medication and seclusion) are frequently used procedures in the management of challenging behaviour. The present study identifies predictors for reactive strategy use in an attempt to more clearly delineate at risk service users.Method Eight hundred and thirty‐nine agencies and service settings in a large area of South Wales were screened to identify children and adults with challenging behaviour against a number of defined operational criteria. Full data were available for 901 participants. Univariate and multivariate statistics were employed to identify predictors for reactive strategy use.Results The individuals most at risk of the use of reactive strategies were those who were subject to formal detention under the Mental Health Act (restraint and sedation), had more severe challenging behaviour (seclusion), showed destructive behaviour (restraint and seclusion) were placed out of area (seclusion) and had behavioural plans in place for specific topographies (restraint and sedation).Conclusions Individual differences such as challenging behaviour and service practices, such as detention under the Mental Health Act, predicted the use of restrictive procedures. The identification of those service users most at risk of reactive strategy use may enable the specific targeting of therapeutic interventions that may reduce or eliminate their use.

Using Staff Training to Decrease the Use of Restrictive Procedures at Two Facilities for Foster Care Children

Objective: Use of some restrictive procedures, including physical restraint, has been controversial. For children within the foster care system, who have already suffered various degrees of abuse and neglect, restrictive procedures could add to their emotional and behavioral problems. The current study was conducted to determine whether a behavioral staff training program would help reduce the use of restrictive procedures at two group facilities housing children in the foster care system. Method: Pre- and posttraining measures (incident reports) were obtained within a nonconcurrent multiple-baseline design to document the use of restrictive procedures. Results: The data revealed decreases in reports of several restrictive procedures (e.g., take downs, physical holds, and physical and pharmacological restraints) at both facilities. Conclusions: The results suggest that training direct care staff personnel, including social workers, in positive behavioral strategies might reduce staff use of restrictive procedures and result in fewer injuries to both children and staff.

Letters

Back to table of contents Previous article Next article LettersFull AccessLettersGregory M. Smith M.S.Aidan Altenor Ph.D.Robert H. Davis M.D.Gregory M. Smith M.S.Search for more papers by this authorAidan Altenor Ph.D.Search for more papers by this authorRobert H. Davis M.D.Search for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.2006.57.4.576aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: The Pennsylvania state hospital system has achieved a culture change that rejects the use of seclusion and restraint. We believe that these traumatizing procedures produce significant barriers to a recovery and have no clinical value. The total elimination of these interventions is a clinical reality for Pennsylvania state hospitals and for many psychiatric facilities worldwide. As of this date, six of our eight state hospitals have eliminated the use of seclusion and two hospitals have eliminated the use of mechanical restraint. Our reliance on these interventions continues to decrease. In January 2006, during which 67,000 days of care were rendered in the civil and forensic services, seclusion was used only two times for a total of 75 minutes, and mechanical restraint was used only seven times for a total of 7.83 hours. This decrease represents a 99.9 percent reduction from the 1996 rate. The transformation occurred without increases in hospital staffing. From 1996 to 2006 the patient-to-staff ratio has remained constant, with an on-unit ratio of one nursing worker for every five patients on the first and second shifts.The "enormous transinstitutionalization" referred to by Dr. Liberman has not been a significant issue for Pennsylvania, which, like other states, provides services to an increasing number of people who have had contact with the criminal justice system. Our approach to service is the same for this group. Indeed, use of seclusion and restraint in our hospitals' forensic centers has historically been much less than in the general (civil) psychiatric service units. In our article we did express concern about use of unscheduled (PRN) medications as a possible substitute for the hands-on use of restrictive procedures. After publication of findings by Thapa and colleagues ( 1 ) of exposure of patients to unnecessary psychotropic medications, our hospital system conducted a 15-month study of the psychiatric use of PRN medications in its nine civil hospitals and three forensic centers. The effort showed widespread differences within the hospitals and forensic centers in exposure rates. The findings led to a uniform policy change that discontinued the psychiatric use of PRN orders in the hospital system in March 2005. Since this change, we have seen marked improvements in our patient safety measures, including further decreases in the use of seclusion and restraint, incidents of aggression, and patient-to-patient assaults with injury ( 2 ). The work of the APA task force on seclusion and restraint cited by Dr. Liberman still represents a good start for any psychiatric facility or clinician wishing to engage in this change. We also recommend the work of the National Technical Assistance Center of the National Association of Mental Health Program Directors: (www.nasmhpd.org/ntac.cfm).Finally, we welcome this kind of exchange and scrutiny. Pennsylvania's state hospital system has been transparent in its efforts to share its experiences. Each month we distribute data to several states in the form of a summary report that details incident data. Interested readers who desire more information or data should contact the first author ([email protected]).

An updated national survey on seclusion and restraint.

A survey of the use of seclusion and restraint during 1994 was conducted at 124 state psychiatric hospitals to update data from a survey of 108 such hospitals conducted for 1991. Rates of patients' placement in seclusion and restraint, hours spent in placement, and discrete incidents of seclusion and restraint were examined. The 1994 results were highly similar to those for 1991. Smaller hospitals providing acute care had higher rates of seclusion and restraint than their larger counterparts providing chronic care. Small positive correlations were found between seclusion and restraint and between the proportion of beds occupied by patients committed as criminally insane and the use of restrictive procedures.

Reducing the use of restrictive procedures in a residential facility.

Restrictive procedures are frequently used in residential facilities for the mentally ill and developmentally disabled despite humanitarian, professional, and legal concerns. Administrators in a regional residential facility for the developmentally disabled instructed staff to reduce the use of seclusion, mechanical restraint, and psychotropic drugs in the facility and set clearly defined policies and procedures on the use of such restraints. Data were gathered on the prevalence of restrictive procedures before and after the new policies were implemented, and staff received frequent feedback. The data showed that in the two and a half years following the adoption of the new policies, the use of seclusion, mechanical restraint, and psychotropic drugs dropped significantly without a concomitant increase in violent incidents, staff turnover, or use of other restrictive procedures. The authors conclude that instructions and feedback are an effective and inexpensive way to reduce the use of restrictive treatment procedures and that the approach used in their facility merits further investigation.