Reducing the Restraints and Seclusions in Child and Adolescent Psychiatirc Inpatient Unites at a Large Psychiatric Health System in Maryland - Staff Level Intervention

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The use of restraints and seclusions in psychiatric inpatient units have been common in both adults and children to manage aggression or to prevent harm to self and others. Center for Medicare and Medicaid has set guidelines about the practice of restraints and seclusions and it is mandatory to report them as Hospital Based Inpatient Psychiatric Services core measures(HBIPS 2 and 3). Literature search suggests that since the introduction of IPFQR by CMS in 2013 there has been considerable decline in restraints and seclusions in psychiatric units in US. Child and Adolescent psychiatric units continue to report a significant number of restraints and seclusions. Younger age, being male, having a history of aggression, being African American and self-harm as well as staff directed aggression have been found to be risk factors for increased restraints and seclusions. There are many studies which have demonstrated that restraints and seclusions can be reduced by implementing various modalities of milieu management and staff training. This project addresses the issue by introducing a trauma informed care based as part of the staff training and orientation. The updating training and psychiatric unit milieu was introduced in early 2022 and project continued from April to August 2022. The number of restraints and seclusion showed a decline from March which was used as baseline, through the following months till August. Our data showed the total restraints declined from 151 in March when intervention was introduced to 110 at the conclusion of the project. The data demonstrated that simple interventions introduced as regular staff training can lead to significant reduction in numbers of restraints and seclusions in child and adolescent inpatient psychiatric units.



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