TJC2024A Note for "Hours of seclusion use"

• Topic Version for Release TJC2024A: 45
• Topic has changed since last release: Compare versions

Rationale

A narrative of the algorithm has been added for accessibility.

Updates to the rationale and references to reflect current evidence.

Description

HBIPS-3: Hours of Seclusion Use Narrative Algorithm was added after the measure flow algorithm.

Rationale
Change from:
Mental health providers that value and respect an individual's autonomy, independence and safety seek to avoid the use of dangerous or restrictive interventions at all times (Donat, 2003). The use of seclusion and restraint is limited to situations deemed to meet the threshold of imminent danger and when restraint and seclusion are used; such use is rigorously monitored and analyzed to prevent future use. Providers also seek to prevent violence or aggression from occurring in their treatment environments by focusing their attention on prevention activities that have a growing evidence base (Donat, 2003).
To:
Mental health providers that value and respect an individual's autonomy, independence and safety seek to avoid the use of dangerous or restrictive interventions at all times (Donat, 2003). The use of seclusion and restraint is limited to situations deemed to meet the threshold of imminent danger and when restraint and seclusion are used; such use is rigorously monitored and analyzed to prevent future use. Providers also seek to prevent violence or aggression from occurring in their treatment environments by focusing their attention on prevention activities that have a growing evidence base (Donat, 2003).

Seclusion or restraint should be initiated only when less restrictive measures have proven ineffective, and the behavioral emergency poses serious and imminent danger to the person, staff, or others. Such interventions should be discontinued as soon as the behavioral criteria for release has been met, and never used as punishment (APNA, 2022).

Providers should first attempt verbal de-escalation, and establish clear protocols to guide decision-making for the initiation and removal of restraint and seclusion (APA, 2022).

Selected References
Add:

• American Psychiatric Association. 2022. APA Resource Document: Seclusion and Restraint. http://apapsy.ch/S-R
• American Psychiatric Nurses Association. 2022. APNA Standards of Practice: Seclusion and Restraint. https://www.apna.org/standards-of-practice-seclusion-and-restraint/

Algorithm
Numerator Statement
Change from: The total number of hours that all psychiatric inpatients spent in seclusion
To: The total number of hours that all psychiatric inpatients were held in seclusion