| Description |
Adults living with profound autism spectrum disorder (PASD), severe intellectual (ID), and developmental disabilities (DD) are routinely admitted to acute psychiatric units for agitation, violent aggression, destructive, and self-injurious behaviors. Acute inpatient psychiatric facilities frequently lack adult sensory resources. Rates of necessitated invasive behavioral interventions, including violent restraints, locked seclusions, and emergent medication administrations, are higher amongst inpatient ID, DD, and PASD patient populations when compared to the general inpatient psychiatric population. Inpatient staff report increased moral distress and work injuries when working with this patient population due to the perceived lack of alternative sensory-sensitive de-escalation and calming environmental resources. The relationship between adult sensory room availability and utilization of locked seclusions, violent restraints, and emergent medication administrations was explored through the development of a transportable sensory room kit for adult ID, DD, and PASD patients admitted to a psychiatric hospital. Local Problem: The Healthy Outcomes Medical Excellence (HOME) Program is comprised of adults with severe ID, DD, and PASD. Primarily an outpatient program, HOME patients are admitted to a large psychiatric hospital for medication adjustments and acute management of exacerbated symptoms inappropriate for outpatient management. Current environmental and unit programming resources do not adequately address the sensory needs of adult HOME patients at this facility. Methods: An initial walking survey was conducted to evaluate current practices and conditions. Baseline rates of locked seclusions, violent restraints, and emergent medication administrations specific to the inpatient HOME population were determined via review of deidentified behavioral event logs. Concurrent feedback was elicited from staff, via in-person discussions, emailed surveys, and posted flyers, to inform the development of a mobile sensory room kit and address the sensory needs of adult HOME patients. The obtained data was used to evaluate whether sensory rooms ameliorate patient aggression and reduce self-injurious behaviors and staff distress. Surveys collected staff experiences, perspectives, and suggestions regarding physical restraints and de-escalation practices specific to the inpatient environment for HOME patients. Interventions: A portable sensory room toolkit and protocol for use was designed and distributed to adjunct skilled de-escalation practices with calming sensory environmental cues for HOME patients admitted to an acute psychiatric setting. The sensory toolkit components included olfactory, tactile, visual, and auditory components informed by literature reviews, staff input, and population specific advocacy groups. Changes to the portable sensory room kit were driven by ongoing staff feedback. Results: A sensory room kit, used an aggregate of 45.1 hours over 16 weeks, was associated with a 100% decrease in violent restraints, 68.75% reduction in emergent medication administrations, and 40% reduction in locked seclusions within the adult HOME patient population. Of the staff surveyed, 94.7% report they would use sensory room kits in the future. Conclusion: Adoption of a relevant, portable sensory room kit as a therapeutic intervention for HOME patients admitted to a psychiatric facility is likely to reduce invasive behavioral interventions, improve desired patient outcomes, and improve overall staff wellbeing. |
