WILLIAM OSLER HEALTH SYSTEM Restraint Minimization David Koczerginski
- Slides: 9
WILLIAM OSLER HEALTH SYSTEM Restraint Minimization David Koczerginski MD FRCPC Chief of Psychiatry William Osler Health System President AGHPS November 9 th, 2012
WILLIAM OSLER HEALTH SYSTEM Jeffrey James Coroner Inquest, September, 2008 • “All psychiatric and schedule 1 facilities in Ontario should aspire to provide care to clients/consumers/survivors in restraint free environments. ”
WILLIAM OSLER HEALTH SYSTEM Restraint Minimization Ø Restraint impact on physical health Ø Restraint impact on patient dignity An appropriate focus of “change” for all schedule 1 facilities in the province of Ontario.
WILLIAM OSLER HEALTH SYSTEM Restraint Minimization Challenges Ø Balancing safety of patient, community, staff Ø Acutely ill/psychotic/agitated/affectively unstable patients. Ø Frontline “duty to detain”
WILLIAM OSLER HEALTH SYSTEM Restraint Minimization Challenges Ø Inpatient focus on risk assessment, treatment of psychosis, community and patient safety with short length of stay. Ø Facility limitations Ø Staffing limitations
WILLIAM OSLER HEALTH SYSTEM Restraint Minimization The Goal Creating an environment that respects patient dignity, ensures staff and patient safety, is respectful of unique multidisciplinary skills and is consistent with the laws of the Province and the realities of clinical practice in acute care hospitals.
WILLIAM OSLER HEALTH SYSTEM Restraint Minimization Strategies Ø Culture change through leadership/discussion/process Ø Data collection Ø Education/training programs Ø Optimizing staff and environment
WILLIAM OSLER HEALTH SYSTEM Restraint Minimization Strategies Ø Emphasize the interdisciplinary team Ø Define the role of specialized Mental Health RN’s Ø Debriefing/reviewing all restraint events
WILLIAM OSLER HEALTH SYSTEM Discussion Mental Health Least Restraint Policies-reviews and “standards”? Observation and monitoring? Re-ordering and 2 nd opinions? PRN restraint orders-mechanical and chemical? Data collection and review? Debriefing practices? Education activity/restraint prevention?
