Presentation on theme: "Restraint Minimization"— Presentation transcript:
1 Restraint Minimization David Koczerginski MD FRCPCChief of PsychiatryWilliam Osler Health SystemPresident AGHPSNovember 9th, 2012
2 Jeffrey 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.”
3 Restraint 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.
4 Restraint Minimization Challenges Balancing safety of patient, community, staffAcutely ill/psychotic/agitated/affectively unstable patients.Frontline “duty to detain”
5 Restraint Minimization Challenges Inpatient focus on risk assessment, treatment of psychosis, community and patient safety with short length of stay.Facility limitationsStaffing limitations
6 Restraint 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.
7 Restraint Minimization Strategies Culture change through leadership/discussion/processData collectionEducation/training programsOptimizing staff and environment
8 Restraint Minimization Strategies Emphasize the interdisciplinary teamDefine the role of specialized Mental Health RN’sDebriefing/reviewing all restraint events
9 DiscussionMental 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?