Presentation on theme: "Restraint Minimization"— Presentation transcript:
1Restraint Minimization David Koczerginski MD FRCPCChief of PsychiatryWilliam Osler Health SystemPresident AGHPSNovember 9th, 2012
2Jeffrey James Coroner Inquest, September, 2008 “All psychiatric and schedule 1 facilities in Ontario should aspire to provide care to clients/consumers/survivors in restraint free environments.”
3Restraint impact on physical health Restraint MinimizationRestraint impact on physical healthRestraint impact on patient dignityAn appropriate focus of “change” for all schedule 1 facilities in the province of Ontario.
4Restraint Minimization Challenges Balancing safety of patient, community, staffAcutely ill/psychotic/agitated/affectively unstable patients.Frontline “duty to detain”
5Restraint Minimization Challenges Inpatient focus on risk assessment, treatment of psychosis, community and patient safety with short length of stay.Facility limitationsStaffing limitations
6Restraint Minimization The Goal Creating an environment that respects patient dignity, ensures staff and patient safety, is respectful of unique multidisciplinary skills and is consistent with the laws of the Province and the realities of clinical practice in acute care hospitals.
7Restraint Minimization Strategies Culture change through leadership/discussion/processData collectionEducation/training programsOptimizing staff and environment
8Restraint Minimization Strategies Emphasize the interdisciplinary teamDefine the role of specialized Mental Health RN’sDebriefing/reviewing all restraint events
9DiscussionMental Health Least Restraint Policies-reviews and “standards”? Observation and monitoring? Re-ordering and 2nd opinions? PRN restraint orders-mechanical and chemical? Data collection and review? Debriefing practices? Education activity/restraint prevention?