Reducing seclusion and restraint: Meeting the organizational challenge

The Mohawk Valley Psychiatric Center has experienced a major reduction in t he use of seclusion and restraint in the past five years. It has used the t raditional quality improvement (QI) tools like the Plan Do Check Act, Flowc harts, Fishbone diagrams, and Parieto Charts as suggested in the QI literat ure. The original work to reduce seclusion and restraint are described in t wo previous articles by Visalli and McNasser.(1,2) This article describes t he additional work since that time. The seclusion/restraint rate in adult s ervice per 1.000 patient days is 0.13 for restraint and 0.15 for seclusion for calendar year 1998. Children and youth service also has comparatively m inimal use of seclusion and restraint. The success of this program is attri buted to the organizational leadership and the interdisciplinary approach t aken to provide individualized treatment. Many of the initiatives stem from a working relationship with patients on how to improve customer service.