Restraint Minimization David Koczerginski MD FRCPC Chief of Psychiatry William Osler Health System President AGHPS November 9th, 2012

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.”

Restraint impact on physical health Restraint Minimization Restraint impact on physical health Restraint impact on patient dignity An appropriate focus of “change” for all schedule 1 facilities in the province of Ontario.

Restraint Minimization Challenges Balancing safety of patient, community, staff Acutely ill/psychotic/agitated/affectively unstable patients. Frontline “duty to detain”

Restraint Minimization Challenges Inpatient focus on risk assessment, treatment of psychosis, community and patient safety with short length of stay. Facility limitations Staffing limitations

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.

Restraint Minimization Strategies Culture change through leadership/discussion/process Data collection Education/training programs Optimizing staff and environment

Restraint Minimization Strategies Emphasize the interdisciplinary team Define the role of specialized Mental Health RN’s Debriefing/reviewing all restraint events

Discussion Mental 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?