1. Restraint Minimization
David Koczerginski MD FRCPC
Chief of Psychiatry
William Osler Health System
President AGHPS
November 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 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.

4. Restraint Minimization Challenges
Balancing safety of patient, community, staff
Acutely 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 limitations
Staffing 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/process
Data collection
Education/training programs
Optimizing staff and environment

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

9. 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?