Mechanical restraint is an intervention used as a last resort to maintain patient safety on inpatient psychiatric units. It is considered the most high-risk intervention for patients due to risk of injury, up to and including death. Staff also put themselves in danger when using this intervention.
This improvement project was done using Improvement Science methods to reduce the use of mechanical restraint on inpatient adolescent units and improve safe patient care delivery in Psychiatry.
Improvement Science methods were used as part of the Intermediate Improvement Science Series course. Key drivers included (A) standardization of milieu expectations; (B) sufficient patient self-regulation period; (C) appropriate staff response to crisis; (D) accurate and timely completion of the Individual Crisis Management Plan; (E) standardization and completion of admission process; and (F) standardization of staff debriefing process following incident.
Several PDSA cycles were performed regarding documentation changes, process updates, job aids, and response of team members to Code Violet situations occurring at the Cincinnati Children’s Hospital Medical Center’s College Hill campus. The most effective intervention tested and adopted was the use of a designated champion to call a “time out” in the process during a code response.
The goal of the project was to decrease mechanical restraint rates on the inpatient adolescent units by 50% (21.4–10.7 weekly incidents per 1,000 patient-days). Through the team’s interventions, we were able to reduce weekly incidents from 21.4 to 2.5 (per 1,000 patient-days), an 88% decrease from baseline rates of mechanical restraint. Because the project’s formal completion in June 2017, the rates have continued to decrease both on the area of focus and throughout the Division of Psychiatry’s inpatient units. It is noted that a shift in the culture of Code Violet response and responders at the College Hill campus that has maintained this progress.