Restraint reduction during psychiatric intensive care: a controlled bi-phasic time series evaluation of a culture change intervention.

backgroundRestrictive practices (ie, physical restraint, rapid tranquilisation and seclusion) are used to manage risk of harm to self and/or others during inpatient psychiatric admissions. Restrictive practices can be physically and psychologically hazardous for both patients and staff, but there have been few well-controlled evaluations of interventions to reduce restrictive practices.

objectiveTo conduct a controlled evaluation of the implementation of a culture change intervention on a psychiatric intensive care unit (PICU) compared with a control PICU on use of restraint.

methodsA new staff role was created on the intervention PICU (ie, the

resultsOn the intervention PICU, there were significant reductions in the use of seclusion, full restraint and use of standing holds. Qualitatively, positive changes to the safety culture of the intervention PICU were reported, and these were consistently rated as important, impactful and unlikely without the RRIA role.

conclusionsPICU safety culture can improve when specific roles focused on changing ward practices around restraints are implemented. More controlled evaluations of reducing restraint interventions on PICUs are needed.