Reducing Patient Restraints: A Pilot Approach Using Clinical Case Review
Results
The results of this project are summarized in Table 1. In tracking the total number of restraints applied to patients From November 2003 to February 2005, a steady decline in the use of restraints is apparent from a range of 29 to 36 episodes per month to 0. The application of restraints to the two multiple-incident patients focused on during the consultation process also steadily decreased over the same period, which averaged approximately a third of the total restraints to 0.
Table 2 lists five factors that may have contributed to the reduction of the use of restraints on the unit; these included the use of a specific clinical case consultation protocol focused on multi-incident patients, a focus on mobilization and enhanced communication among the treatment team and ward staff, staff training, small group projects to enhance program organization, and instituting staff supports to enable a refocusing of attitudes toward patients and the various factors contributing to patients’ behaviors.
In reviewing the consultation process with the unit treatment team and ward staff, it was concluded that the unit had changed from one that placed excessive reliance on mechanical restraints to minimize patient disruptive behaviors to one that utilized a more ecological perspective that included modifying setting conditions that precipitated aggressive behaviors and instituted more individualized approaches to patient behaviors, needs, and characteristics.