Reducing the use of seclusion and restraint: a Michigan provider reduced its use of seclusion and restraint by 93% in one year on its child and adolescent unit.

times per day. Patients are randomly assigned One hallway of rooms is designated as

rooms in all hallways. a quiet area to bring patients to as

initial stages of a crisis are noted

so the patient no longer has an

"audience." There is no extra staffing when There is more 1:1 staffing in the

patients are in crisis unless quiet hall. Safety guidelines are in

seclusion or restraint place, and negative behaviors are not

techniques are used. rewarded with attention. All patient interaction takes While isolated, a patient is able to

place within the sight or "save face" with peers and work

earshot of peers. through issues causing crisis moments. Private journaling time in There is much less quiet time in

individual rooms is scheduled rooms.

for two hours per day. Patients spend more time viewing Physical activity is planned

educational videos, with not intentionally into the patients' day.

much planned physical activity

time. Patients are infrequently in the Patients spend more time in the

courtyard. courtyard. A rigid structure is in place. A less rigid structure is in place.

For example, patients must Patients may negotiate with staff.

drink all their milk before

getting dessert. Attendance at

scheduled groups is mandatory. Table 2. Staff injuries related to patient care

2006 2007 Number of injuries 87 73 Patient days 8,353 7,597 Staff injuries per 1,000 days 10.4 9.6 Table 3. Patient injuries from inappropriate patient-patient and patient-staff interactions

2006 2007 Number of injuries 24 17 Patient days 8,353 7,597 Injuries per 1,000 days 2.9 2.2