The Trauma Informed Care Model: Reducing the Need for Seclusion and Restraint Use A Quality Improvement Project

Abstract

Purpose: The purpose of this quality improvement project is to decrease the frequency and duration of seclusion and restraint (S/R) use at a women’s inpatient psychiatric unit by increasing the organizational awareness of Trauma Informed Care (TIC). Background: The use of S/R interventions within the field of mental healthcare can result in psychological harm, physical injury, and even death to patients and healthcare staff. S/R use can contribute to many poor patient outcomes such as re-traumatization and increase the length of hospitalization and threaten the therapeutic alliance between patients and staff members. The TIC model acknowledges the correlation between cumulative trauma and poor health outcomes and works to create an approach where patient centered care is delivered by all healthcare professionals without retraumatizing the patient or staff members. Sample/Setting: An inpatient psychiatric women’s unit with 40 beds. Methods: A pre and post project data comparison was performed of the site’s S/R database and two training courses on TIC and de-escalation techniques were provided to all nursing services staff members. A pre and post survey was offered to each staff member to assess the effectiveness of the education. Results: During project implementation, the weekly average frequency of S/R use decreased by 40% and the average duration of time spent in S/R decreased by 38% in patients assigned to the women’s unit. Conclusion: The application of the educational sessions correlated to a decrease in both the frequency and duration of S/R use.