Improving De-escalation Techniques in a Psychiatric Setting

Background:Violence towards those working in the mental health field is a known problem, consisting of physical assaults, verbal assaults, and threats of harm regularly. Healthcare workers in mental health facilities are at an increased risk of violence at the hands of the patients for whom they care. Ridenour et al. (2015) found that 20% were physically assaulted, 43% were threatened with harm, and over 50% were verbally assaulted at least once during a single workweek. Lack of adequate training in de-escalation of agitated patients is one factor that has been identified as contributing to employee and patient injury. Often, restraints andor seclusion are tools used to control agitated and violent patients. These interventions in themselves present situations where staff and patients can sustain injury. Thepurposeof this project is toboth increase staff knowledge and confidence in de-escalating an agitated patient with the added goal of decreasing the usage of seclusion and restraints. Methods:A quality improvement project was developed to assist the direct-care staff on one forensic unit in a psychiatric hospital in improving de-escalation techniques to decrease the use of chemical and physical restraints. Staff understanding of mental illness, their confidence in their de-escalation abilities, their experience with physical or verbal assault, as well as their personal views on the use of restraints was assessed via a pre-workshop survey. An educational workshop was developed and covered such areas as the pathology of mental illness, how it manifests on the patients we care for, mechanism of action of various psychotropic medications, and de-escalation techniques. A quiz to assess content recall and a post-workshop survey to monitor changes in staff opinions and confidence were completed by participants. A record search of the unit's EHR was conducted pre and post-workshop to monitor changes in the incident rate of restraint and seclusion use. Results:Of the 20 participantswho attended the workshop, 95% (n=19) reported feeling more confident de-escalating an agitated patient. 85% (n=17) reported feeling more empathy towards their patients. 85% (n=17) reportedthey understand the nature of mental illness, its causes, and how & why it manifests the way it does. 100% (n=20) thought the content applied to their jobs and 90% (n=18) planned to use the information in their work. According to the EHR there was no difference in restraint use pre and post-intervention.Conclusions:The workshop was effective in meeting the objectives of increasing the knowledge base and confidence of participants.This project illustrates the necessity of adequate training of those who will be workingmentallyill patients.The workshop should beconducted for all in-patient units in the facility and post-workshop data should be collected for a longer period to better determinethe efficacy of this project.