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Brief Reports   |    
Anatomy of a Transformation: A Systematic Effort to Reduce Mechanical Restraints at a State Psychiatric Hospital
Jenna L. Godfrey, Ph.D.; Amanda C. McGill, R.N., M.S.N.; Nicole Tuomi Jones, Ph.D.; Stephen L. Oxley, M.D.; Robyn M. Carr, M.P.A.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300247
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The authors are with the Central Regional Hospital, Butner, North Carolina (e-mail: jenna.godfrey@dhhs.nc.gov). Dr. Godfrey and Dr. Jones are with the Department of Psychology, Ms. McGill is the chief nursing officer, Dr. Oxley is the chief medical officer, and Ms. Carr is the director of quality management.

Copyright © 2014 by the American Psychiatric Association


Objective  The authors describe efforts to reduce use of mechanical restraints at a state psychiatric hospital.

Methods  Data were collected for individuals admitted to the acute adult unit (AAU) (N=2,910) and the community transition unit (CTU) (N=334) over three years. Two strategies aimed to reduce mechanical restraint use. First, staff were trained in deescalation techniques, and a response team was formed for crisis situations. Second, a policy change required prior approval for use of mechanical restraint.

Results  Mechanical restraint was significantly reduced on both units after the first strategy. After the second, additional reduction was noted on AAU (98% total reduction) but not on CTU, where the practice had already been eliminated. No increase in assaults or injuries was noted.

Conclusions  Reduction in mechanical restraint use is possible through deescalation skills training, use of a response team, and policy changes. Strong leadership, staff buy-in, provision of feedback, and quality monitoring were also instrumental.

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Table 1Daily incidence rates of variables monitored over a three-year effort to reduce mechanical restraint use at a state psychiatric hospitala
Table Footer Note

a AAU, acute adult unit; CTU, community transition unit. Baseline period, 12 months on AAU and CTU; phase I, 12 months on AAU and 11 months on CTU; phase II, 11 months on AAU and 12 months on CTU. Daily incidence rate was defined as the total number of events (for example, N of persons placed in mechanical restraints) divided by the number of persons at risk for an event (that is, total N of persons on the unit that day).

Table Footer Note

b Baseline, 1; phase I, 2; phase II, 3

Table Footer Note

c Wilks’ λ=.855; partial η2=.076, power=1.00

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d Analysis of variance; partial η2=.101, power=1.00

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e Wilks’ λ=.845, partial η2=.081, power=1.00

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f Analysis of variance; partial η2=.021, power=.992

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*p<.05, **p<.01, ***p<.001



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