Use of Rapid Cycle Improvement to Reduce Restraint and Seclusion in a Psychiatric Service

2.50
Hdl Handle:
http://hdl.handle.net/10755/153674
Type:
Presentation
Title:
Use of Rapid Cycle Improvement to Reduce Restraint and Seclusion in a Psychiatric Service
Abstract:
Use of Rapid Cycle Improvement to Reduce Restraint and Seclusion in a Psychiatric Service
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Main, Cheryl, MSN/MN/MNSc/MNE
P.I. Institution Name:Community Health Network
Title:Quality Coordinator
Objective: The goal of this project was to reduce the use of restraint and seclusion in seven inpatient psychiatric units 50% over the period of 6 months. Design: A quasi-experimental time-series design consisted of periodic measurement of the percent of patients being restrained and secluded as a series of interventions occurred. Population, Sample, Setting: Two nurse directors and four nurse coordinators in consultation with the quality coordinator, medical director, educator, and vice president led the improvement project. The behavioral care service, a department of a large metropolitan health care network, included inpatient psychiatric units for youth, adults, and senior adults. These units provided care for patients who were a danger to themselves or others, or unable to care for themselves due to acute symptoms of psychiatric disorders. A multidisciplinary staff of psychiatrists, psychiatric nurses, mental health clinicians, social workers, activity therapists, and a pharmacist provided treatment for the 100-bed inpatient service. Intervention and Outcome Variables: The outcome variables were monthly counts of the percent of patients who received restraint and percent of patients who received seclusion while being treated at the inpatient psychiatric service. The intervention was a series of specific cycles of improvements involving: (1) change of policy and chart forms, (2) consultation, (3) training, (4) half-day didactic/discussion with all patient care and security staff, (5) implementation, and (6) maintenance. Method: A serial "V" process of multiple cycles of PDSA (plan, do, study, act) was implemented as a process improvement project. The team of nurse leaders developed a plan for structured incremental changes across a period of months. Data was plotted monthly on control charts and analyzed. Findings: Control charts for restraint of youth and adult patients demonstrated a series of data points that dropped below the mean across more than 6 months. The control chart for youth who were secluded also demonstrated a series of data points that dropped below the mean across more than 6 months. The percent of adults who were secluded did not show a shift of data points below the mean. Use of Rapid Cycle 2 Conclusions: The use of rapid cycle improvement with the multiple cycles of specific interventions was effective in reducing the use of restraint and seclusion of youth and restraint of adults. The goal of reducing the use of restraint and seclusion by 50% was achieved. Implications: Restraint and seclusion are associated with high risk of injury for both staff and patients. Regulatory and accreditation agencies have demanded reduction on these two interventions. Implementation of the serial "V" rapid cycle improvement was demonstrated as a very effective and practical method for reduction of restraint and seclusion.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleUse of Rapid Cycle Improvement to Reduce Restraint and Seclusion in a Psychiatric Serviceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/153674-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Use of Rapid Cycle Improvement to Reduce Restraint and Seclusion in a Psychiatric Service</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Main, Cheryl, MSN/MN/MNSc/MNE</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Community Health Network</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Quality Coordinator</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">smain@ehealthindiana.com</td></tr><tr><td colspan="2" class="item-abstract">Objective: The goal of this project was to reduce the use of restraint and seclusion in seven inpatient psychiatric units 50% over the period of 6 months. Design: A quasi-experimental time-series design consisted of periodic measurement of the percent of patients being restrained and secluded as a series of interventions occurred. Population, Sample, Setting: Two nurse directors and four nurse coordinators in consultation with the quality coordinator, medical director, educator, and vice president led the improvement project. The behavioral care service, a department of a large metropolitan health care network, included inpatient psychiatric units for youth, adults, and senior adults. These units provided care for patients who were a danger to themselves or others, or unable to care for themselves due to acute symptoms of psychiatric disorders. A multidisciplinary staff of psychiatrists, psychiatric nurses, mental health clinicians, social workers, activity therapists, and a pharmacist provided treatment for the 100-bed inpatient service. Intervention and Outcome Variables: The outcome variables were monthly counts of the percent of patients who received restraint and percent of patients who received seclusion while being treated at the inpatient psychiatric service. The intervention was a series of specific cycles of improvements involving: (1) change of policy and chart forms, (2) consultation, (3) training, (4) half-day didactic/discussion with all patient care and security staff, (5) implementation, and (6) maintenance. Method: A serial &quot;V&quot; process of multiple cycles of PDSA (plan, do, study, act) was implemented as a process improvement project. The team of nurse leaders developed a plan for structured incremental changes across a period of months. Data was plotted monthly on control charts and analyzed. Findings: Control charts for restraint of youth and adult patients demonstrated a series of data points that dropped below the mean across more than 6 months. The control chart for youth who were secluded also demonstrated a series of data points that dropped below the mean across more than 6 months. The percent of adults who were secluded did not show a shift of data points below the mean. Use of Rapid Cycle 2 Conclusions: The use of rapid cycle improvement with the multiple cycles of specific interventions was effective in reducing the use of restraint and seclusion of youth and restraint of adults. The goal of reducing the use of restraint and seclusion by 50% was achieved. Implications: Restraint and seclusion are associated with high risk of injury for both staff and patients. Regulatory and accreditation agencies have demanded reduction on these two interventions. Implementation of the serial &quot;V&quot; rapid cycle improvement was demonstrated as a very effective and practical method for reduction of restraint and seclusion.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T12:26:06Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T12:26:06Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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