Improving Patient Safety by Reducing the Use of Restraint and Seclusion through De-escalation in an Inpatient Psychiatric Unit

Authors

Ndidiamaka Okafor, University of Texas Health Science Center at HoustonFollow

Author Biographical Info

Ndidiamaka Okafor is a final-year Psychiatric-Mental Health Nurse Practitioner Doctorate student at the University of Texas Health Science Center at Houston, Cizik School of Nursing. She has over 6 years of experience as a registered nurse providing healthcare services to patients. Ndidiamaka is deeply passionate about reducing health disparities and advancing equitable access to quality mental health care for vulnerable and underserved populations. She aims to empower individuals through advocacy, education, and culturally sensitive care that supports holistic wellness and recovery.

Date of Doctor of Nursing Practice Project Completion

Spring 5-1-2024

Faculty Advisor

Dr. Francine Snow

Abstract

Improving Patient Safety by Reducing the Use of Restraint and Seclusion through De-escalation in an Inpatient Psychiatric Unit

PURPOSE:

The purpose of this quality improvement project is to improve safety among adolescent patients ages 13 – 17 on an inpatient psychiatric unit through improved staff de-escalation techniques as evidenced by a decrease in the use of restraint and seclusion combined by 23% from 65% to 50% within 3 months. A secondary aim is that staff will provide self-reported improvement in confidence.

BACKGROUND:

Aggression from adolescents admitted to the inpatient psychiatric unit is one challenge nursing staff face when providing care. This violent behavior can cause harm to patients and staff. Restrictive measures such as physical restraint and seclusion are used to control aggressive situations when other interventions have proven to be ineffective.

METHODOLOGY:

The Plan-Do-Study-Act (PDSA) quality improvement model was used as a guideline for implementation. Education on the science of de-escalation was provided. A survey assessed pre/post-knowledge among nurses and mental health technicians. Data were gathered through the risk management department.

RESULTS:

Survey results showed that nurses and technicians strongly agreed they felt confident in performing de-escalation techniques after training. The pre-score was 70% and the post-score was 100%. Restraint and seclusion use decreased immediately and remained low. The goal of reducing use from 65% to 50% was met and exceeded.

IMPLICATIONS:

Implementing evidence-based de-escalation techniques can reduce the usage of restraint and seclusion in adolescent inpatient units and can improve patient and staff safety. Nurses and techs must understand the evidence behind de-escalation. Nurse leaders should advocate for evidence-based de-escalation education to improve patient care and outcomes.

Keywords

Mental health, De-escalation techniques, Physical restraint, Seclusion, Adolescent, Inpatient psychiatric unit.

Recommended Citation

Ndidiamaka Okafor, "Improving Patient Safety by Reducing the Use of Restraint and Seclusion through De-escalation in an Inpatient Psychiatric Unit" (2024). Doctor of Nursing Practice Final Project Abstract. 135.
https://digitalcommons.library.tmc.edu/dnp_abstract/135