OBJECTIVE: To evaluate the impact of the implementation of a guideline for the management of personality disorders on reducing the frequency of use of mechanical restraints in a psychiatric inpatient unit. METHOD: This retrospective study was conducted in a psychiatric inpatient unit with 42 beds, which serves an urban area of 330,000 inhabitants. The sample consisted of all patients with a clinical diagnosis of personality disorder (DSM-IV-TR criteria) who were admitted to the unit from January 2010 to December 2010 and from January 2011 to December 2011 (ie, before and after, respectively, the implementation of the guideline). The guideline focused on cluster B disorders and follows a psychodynamic perspective. RESULTS: Restraint use was reduced from 38 of 87 patients with personality disorders (43.7%) to 3 of 112 (2.7%), for a relative risk of 0.06 (95% CI, 0.02-0.19) and an absolute risk reduction of 41% (95% CI, 29.9%-51.6%). The risk of being discharged against medical advice increased after the intervention, with a relative risk of 1.84 (95% CI, 0.96-3.51). Restraint use in patients with other diagnoses was also reduced to a similar extent. CONCLUSIONS: The use of mechanical restraints was dramatically reduced after the implementation of a clinical practice guideline on personality disorders, suggesting that these coercive measures might be decreased in psychiatric inpatient units.
OBJECTIVE: To evaluate the impact of the implementation of a guideline for the management of personality disorders on reducing the frequency of use of mechanical restraints in a psychiatric inpatient unit. METHOD: This retrospective study was conducted in a psychiatric inpatient unit with 42 beds, which serves an urban area of 330,000 inhabitants. The sample consisted of all patients with a clinical diagnosis of personality disorder (DSM-IV-TR criteria) who were admitted to the unit from January 2010 to December 2010 and from January 2011 to December 2011 (ie, before and after, respectively, the implementation of the guideline). The guideline focused on cluster B disorders and follows a psychodynamic perspective. RESULTS: Restraint use was reduced from 38 of 87 patients with personality disorders (43.7%) to 3 of 112 (2.7%), for a relative risk of 0.06 (95% CI, 0.02-0.19) and an absolute risk reduction of 41% (95% CI, 29.9%-51.6%). The risk of being discharged against medical advice increased after the intervention, with a relative risk of 1.84 (95% CI, 0.96-3.51). Restraint use in patients with other diagnoses was also reduced to a similar extent. CONCLUSIONS: The use of mechanical restraints was dramatically reduced after the implementation of a clinical practice guideline on personality disorders, suggesting that these coercive measures might be decreased in psychiatric inpatient units.
Authors: Louise Nelstrop; Jackie Chandler-Oatts; William Bingley; Tony Bleetman; Frank Corr; Jane Cronin-Davis; Donna-Maria Fraher; Phil Hardy; Sophie Jones; Kevin Gournay; Sue Johnston; Stephen Pereira; Peter Pratt; Rick Tucker; Aki Tsuchiya Journal: Worldviews Evid Based Nurs Date: 2006 Impact factor: 2.931
Authors: Johan Ohlenschlaeger; Merete Nordentoft; Anne Thorup; Pia Jeppesen; Lone Petersen; Torben Ø Christensen; Gertrud Krarup; Per Jørgensen Journal: Int J Law Psychiatry Date: 2008-01-09
Authors: Jirí Raboch; Lucie Kalisová; Alexander Nawka; Eva Kitzlerová; Georgi Onchev; Anastasia Karastergiou; Lorenza Magliano; Algirdas Dembinskas; Andrzej Kiejna; Francisco Torres-Gonzales; Lars Kjellin; Stefan Priebe; Thomas W Kallert Journal: Psychiatr Serv Date: 2010-10 Impact factor: 3.084
Authors: Christoph Abderhalden; Ian Needham; Theo Dassen; Ruud Halfens; Hans-Joachim Haug; Joachim E Fischer Journal: Br J Psychiatry Date: 2008-07 Impact factor: 9.319
Authors: Tilman Steinert; Frank Eisele; Ulla Goeser; Stefan Tschoeke; Carmen Uhlmann; Peter Schmid Journal: Clin Pract Epidemiol Ment Health Date: 2008-11-17