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Searby A, James R, Snipe J, Maude P. Locked external doors on inpatient mental health units: A scoping review. Int J Ment Health Nurs 2023; 32:1544-1560. [PMID: 37409776 DOI: 10.1111/inm.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
The principles of least restrictive care and recovery-focused practice are promoted as contemporary practice in the care of individuals with mental ill health, underpinning legislation concerning mental health and illness in many jurisdictions worldwide. Inpatient mental health units with locked doors are incompatible with this style of care and throwback to a time where care for mental illness was primarily custodial. The aim of this scoping review is to determine whether evidence exists for locking mental health unit doors, whether this practice is compatible with recovery-focused care and to determine whether door locking has changed since a review conducted by Van Der Merwe et al. (Journal of Psychiatric and Mental Health Nursing, 16, 2009, 293) found that door locking was not the preferred practice in the management of acute mental health units. We used Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8, 2005, 19) framework for scoping reviews, with our initial search locating 1377 studies, with screening narrowing final papers for inclusion to 20. Methodologies for papers included 12 using quantitative methodology, 5 qualitative and 3 that used mixed methods designs. Poor evidence was found for door locking to mitigate risks such as absconding, aggression or illicit substance importation. Furthermore, locked doors had a detrimental impact on the therapeutic relationship, nurse job satisfaction and intention to leave the profession. This scoping review indicates that research is urgently needed to address a mental healthcare culture where door locking is an entrenched practice. Studies of alternative approaches to risk management are required to ensure inpatient mental health units are truly least-restrictive, therapeutic environments.
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Affiliation(s)
- Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Russell James
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jim Snipe
- Five Arcs Consultancy, Melbourne, Victoria, Australia
| | - Phil Maude
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, Latrobe University, Melbourne, Victoria, Australia
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2
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Goulet MH, Lessard-Deschênes C. Le Modèle de prévention de l’utilisation des mesures de contrôle en santé mentale : une revue intégrative. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094149ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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3
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Abstract
The appropriate treatment of mentally unwell, aggressive patients has challenged psychiatry for centuries. Seclusion is practiced worldwide, but concerns remain regarding its appropriateness and lack of alternatives. Patients generally report seclusion as a negative experience, though there is a paucity of literature exploring this in detail. This investigation was a service evaluation appraising inpatients' perspective of processes occurring before (information, communication), during (review, care), and after (debrief, reflection) seclusion in a psychiatric intensive care unit (PICU). In this phenomenological study, qualitative data were gathered using a questionnaire in a structured interview. All patients had been nursed in seclusion during admission to a male PICU at South London and the Maudsley NHS Foundation Trust. Ten patients were interviewed over 4 months. The central theme was perceived lack of communication in the patient-professional relationship, which manifested itself as (i) violence against patients, (ii) lack of psychological support, and (iii) the need for alternatives. Such feedback from patients queries whether national guidelines are appropriate and/or being adhered to. Healthcare practitioners have a responsibility to challenge accepted practice to continually improve the standard of patient-centred care. Utilising patient perspectives can be a powerful driver of change towards more humane treatment of vulnerable patients.
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Affiliation(s)
- Silvia Allikmets
- Department of Life Sciences & Medicine, GKT School of Medical Education, King's College London, London, United Kingdom
| | - Caryl Marshall
- Southwark High Support Rehabilitation, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.,Community Forensic LD/ASD, Oxleas NHS Foundation Trust, South London Partnership, London, United Kingdom
| | - Omar Murad
- Psychiatric Intensive Care, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kamal Gupta
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
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4
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Muir-Cochrane E, Oster C, Grimmer K. International research into 22 years of use of chemical restraint: An evidence overview. J Eval Clin Pract 2020; 26:927-956. [PMID: 31318109 DOI: 10.1111/jep.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non-consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others. Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice. AIMS To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995. METHODS This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures. RESULTS This review identified 311 relevant primary studies (21 RCTs; 46 non-controlled experimental or prospective observational studies; 77 cross-sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross-country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). DISCUSSION A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non-consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non-chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research.
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042
| | - Candice Oster
- On-Line Education and Development, Flinders Human Behaviour and Health Research Unit (FHBHRU), College of Medicine and Public Health, Flinders University, South Australia, Australia, 5042
| | - Karen Grimmer
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042.,Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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5
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Huber CG, Schneeberger AR. Editorial: Compulsory Interventions in Psychiatry: An Overview on the Current Situation and Recommendations for Prevention and Adequate Use. Front Psychiatry 2020; 11:622373. [PMID: 33364991 PMCID: PMC7750427 DOI: 10.3389/fpsyt.2020.622373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Christian G Huber
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Andres R Schneeberger
- Psychiatric Services Grisons, Chur, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, United States
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6
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Steinauer R, Krückl JS, Moeller J, Vogel M, Wiesbeck GA, Walter M, Lang UE, Huber CG. Opening the Doors of a Substance Use Disorder Ward-Benefits and Challenges From a Consumer Perspective. Front Psychiatry 2020; 11:580885. [PMID: 33192724 PMCID: PMC7541831 DOI: 10.3389/fpsyt.2020.580885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
Open doors in psychiatry have been a subject of controversy in recent years. While some studies postulate the clinical necessity of closed doors, others challenge the theoretical advantages of this setting, mention numerous drawbacks of closed wards, and focus on the advantages of open-door settings. With regard to patients diagnosed with substance use disorders (SUD), other standards may apply. Very little research has been done on this topic. Some studies adopted a consumer perspective (i.e. asking involved parties about their experience of the door status). To the authors' knowledge, no study has so far addressed the ideal setting for the treatment of SUD. With our data from the opening of a specialized SUD ward, we take one step to closing this knowledge gap. Applying a qualitative design, we asked patients and health care professionals (HCP) to report changes following the opening of the ward. The results are mainly in line with the literature on the general psychiatric population. The newly introduced open-door setting was mostly perceived as positive, but some disadvantages were mentioned (e.g. less protection of patients, less control over who enters/leaves the ward, the theoretically increased risk of patients absconding). Moreover, HCP (but not patients) mentioned potentially increased substance use on the ward as an additional disadvantage that could arise. Opening a previously closed ward was generally perceived as a positive and progressive decision. These findings support the trend towards an overall open-door policy in psychiatry.
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Affiliation(s)
- Regine Steinauer
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Jana S Krückl
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Julian Moeller
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland.,Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Marc Vogel
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Gerhard A Wiesbeck
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Marc Walter
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Undine E Lang
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Christian G Huber
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
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8
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Kowalinski E, Hochstrasser L, Schneeberger AR, Borgwardt S, Lang UE, Huber CG. [Six years of open-door policy at the University Psychiatric Hospital Basel]. DER NERVENARZT 2019; 90:705-708. [PMID: 31101956 DOI: 10.1007/s00115-019-0733-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coercive measures in psychiatry have well-known negative consequences for the patients and their treatment. They are considered ethically problematic and must only be used as a last resort. Locked wards may promote a threatening atmosphere leading to more aggression and a subsequent higher use of coercive measures. The aim of this was to investigate the frequency of seclusion and forced medication during clinic-wide implementation of an open-door policy. MATERIAL AND METHODS In this 6‑year longitudinal observational study (2010-2015) the frequencies of seclusion and forced medication were investigated on the basis of 17,359 cases treated in the University Psychiatric Hospital Basel. During the observational period, six formerly permanently locked wards were opened. RESULTS The examined data showed a clinically relevant decrease in the frequency of seclusion (from 8.2% to 3.5%) and forced medication (from 2.4% to 1.2%) during the observational period. CONCLUSION These results underline the potential of a less restrictive policy in psychiatry to reduce the frequency of coercive measures.
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Affiliation(s)
- Eva Kowalinski
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Kornhausgasse 7, 4051, Basel, Schweiz.
| | - Lisa Hochstrasser
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Kornhausgasse 7, 4051, Basel, Schweiz
| | - Andres R Schneeberger
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Kornhausgasse 7, 4051, Basel, Schweiz.,Psychiatrische Dienste Graubünden, Chur, Schweiz.,Albert Einstein College of Medicine, New York, USA
| | - Stefan Borgwardt
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Kornhausgasse 7, 4051, Basel, Schweiz
| | - Undine E Lang
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Kornhausgasse 7, 4051, Basel, Schweiz
| | - Christian G Huber
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel, Universität Basel, Kornhausgasse 7, 4051, Basel, Schweiz
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9
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Steinert T, Schreiber L, Metzger FG, Hirsch S. [Open doors in psychiatric hospitals : An overview of empirical findings]. DER NERVENARZT 2019; 90:680-689. [PMID: 31165212 DOI: 10.1007/s00115-019-0738-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, it is a topic of debate whether psychiatric hospitals can and should be managed with a full open door policy. The revised legislation of public law for involuntary commitment explicitly allows or even encourages such practice in several German federal states. In parts of Austria, open doors are required for legal reasons. A systematic literature search was conducted for articles providing empirical data related to this issue. METHOD Literature search in PubMed augmented by a manual search in references of retrieved papers and reviews with similar objectives. RESULTS A total of 26 articles reporting empirical data could be identified. Most of these articles came from Germany or Switzerland. The majority were published within the past 5 years. The definition of "open doors" ranged from an only vaguely defined open door policy up to explicit set time periods with open doors. Some studies reported a decrease in coercive interventions. No study reported any associated adverse events resulting from open doors in psychiatric wards. DISCUSSION Generally, all studies had methodological weaknesses. Prospective randomized controlled studies or quasi-experimental studies are missing in the context of European healthcare systems. The risk of bias was considerable in most studies. A final conclusion regarding the possible extent of psychiatry with open doors and the associated risks is currently not possible. There is an urgent need for future high-quality prospective studies.
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Affiliation(s)
- Tilman Steinert
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm (Weissenau), ZfP Südwürttemberg, Weingartshofer Str. 2, 88214, Ravensburg Weissenau, Deutschland.
| | - Lisa Schreiber
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Florian G Metzger
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland.,Geriatrisches Zentrum, Universitätsklinikum Tübingen, Tübingen, Deutschland.,Vitos Klinik für Psychiatrie und Psychotherapie Haina, Haina, Deutschland
| | - Sophie Hirsch
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm (Weissenau), ZfP Südwürttemberg, Weingartshofer Str. 2, 88214, Ravensburg Weissenau, Deutschland
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10
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Hirsch S, Steinert T. Measures to Avoid Coercion in Psychiatry and Their Efficacy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:336-343. [PMID: 31288909 PMCID: PMC6630163 DOI: 10.3238/arztebl.2019.0336] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 08/20/2018] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Coercive measures such as seclusion and restraint encroach on the patient's human rights and can have serious adverse effects ranging from emotional trauma to physical injury and even death. At the same time, they may be the only way to avert acute danger for the patient and/or the hospital staff. In this article, we provide an overview of the efficacy of the measures that have been studied to date for the avoidance of coercion in psychiatry. METHODS This review is based on publications retrieved by a systematic search in the Medline and Cinahl databases, supplemented by a search in the reference lists of these publications. We provide a narrative synthesis in which we categorize the interventions by content. RESULTS Of the 84 studies included in this review, 16 had a control group; 6 of these 16 were randomized controlled trials (RCTs). The interventions were categorized by seven different types of content: organization, staff training, risk assessment, environment, psychotherapy, debriefings, and advance directives. Most interventions in each category were found to be effective in the respective studies. 38 studies investigated complex treatment programs that incorporated elements from more than one category; 37 of these (including one RCT) revealed effective reduction of the frequency of coercion. Two RCTs on the use of rating instruments to assess the risk of aggressive behavior revealed a relative reduction of the number of seclusion measures by 27% and a reduction of the cumulative duration of seclusion by 45%. CONCLUSION Complex intervention programs to avoid coercive measures, incorporating elements of more than one of the above categories, seem to be particularly effective. In future, cluster-randomized trials to investigate the individual categories of intervention would be desirable.
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Affiliation(s)
- Sophie Hirsch
- ZfP Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau
| | - Tilman Steinert
- ZfP Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau
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Arnold BD, Moeller J, Hochstrasser L, Schneeberger AR, Borgwardt S, Lang UE, Huber CG. Compulsory Admission to Psychiatric Wards-Who Is Admitted, and Who Appeals Against Admission? Front Psychiatry 2019; 10:544. [PMID: 31447710 PMCID: PMC6695555 DOI: 10.3389/fpsyt.2019.00544] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/15/2019] [Indexed: 12/03/2022] Open
Abstract
Background: When persons with a mental illness present a danger to themselves or others, involuntary hospital admission can be used to initiate an immediate inpatient treatment. Often, the patients have the right to appeal against compulsory admission. These processes are implemented in most mental health-care systems, but regulations and legal framework differ widely. In the Swiss canton of Basel-Stadt, a new regulation was implemented in January 2013. While the current literature holds some evidence for factors associated with involuntary admission, knowledge on who uses the right to appeal against admission is sparse. Aims: The study aims to examine if specific sociodemographic and clinical characteristics are associated with involuntary admission and with an appeal against the compulsory admission order. Method: Routine clinical data of all inpatient cases admitted during the period from January 2013 to December 2015 at the Psychiatric University Hospital Basel were extracted. Generalized estimating equation (GEE) analyses were used to examine the association of sociodemographic and clinical characteristics with "involuntary admission" and "appeal against compulsory admission order." Results: Of the 8,917 cases included in the present study, 942 (10.6%) were admitted involuntarily. Of these, 250 (26.5%) lodged an appeal against the compulsory admission order. Compared with cases admitted on a voluntary legal status, cases admitted involuntarily were older and were admitted more often during the nighttime or weekend. Moreover, involuntarily admitted cases had more often a principal diagnosis of a schizophrenia spectrum disorder. Patients from cases where an appeal was lodged were more often female, had more often Swiss nationality, and were more often diagnosed with schizophrenia spectrum disorder. Conclusion: Despite legal changes, the frequency of involuntary admissions in the observed catchment area seems to be relatively stable across the last 20 years. The percentage of appeals has decreased from 2000 to 2015, and only comparably few patients make use of the possibility to appeal. Better knowledge of the regulations, higher social functioning, and lower insight into illness might be associated with a higher probability of lodging an appeal. Future research should examine if specific patient groups are in need of additional assistance to exert their rights to appeal.
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Affiliation(s)
- Benjamin D Arnold
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
| | - Julian Moeller
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland.,Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Lisa Hochstrasser
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
| | - Andres R Schneeberger
- Psychiatrische Dienste Graubünden (PDGR), Chur, Switzerland.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine (AECOM), Bronx, NY, United States.,Psychiatrische Universitätsklinik (PUK), Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universität Zürich, Zurich, Switzerland
| | - Stefan Borgwardt
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
| | - Undine E Lang
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
| | - Christian G Huber
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
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12
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Hochstrasser L, Voulgaris A, Möller J, Zimmermann T, Steinauer R, Borgwardt S, Lang UE, Huber CG. Reduced Frequency of Cases with Seclusion Is Associated with "Opening the Doors" of a Psychiatric Intensive Care Unit. Front Psychiatry 2018. [PMID: 29535651 PMCID: PMC5834654 DOI: 10.3389/fpsyt.2018.00057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Implementing an open door policy is a complex intervention comprising changes in therapeutic stance, team processes, and a change from locked to open doors. Recent studies show that it can lead to a reduction of seclusion and forced medication, but the role of the physical change of door status is still unclear. AIMS The aims of this study is to examine the transition from closed to predominantly open doors on a psychiatric intensive care unit (PICU) and its associations with the frequency of seclusion and forced medication. METHOD A PICU at the Department of Adult Psychiatry, University of Basel, Switzerland, implemented evidence-based strategies for operating an open door policy within the context of acute psychiatry and participated in a hospital-wide implementation of an open door policy before changing door status. 131 inpatient cases hospitalized on this PICU were examined regarding the frequency of seclusion and forced medication using explorative analyses over a time span of 32 weeks (16 weeks after implementation of the new treatment concept but before door opening, 16 weeks after door opening). RESULTS Following door status change, the PICU was completely open on 51% of the days and partly open on 23% of the days. The mean number of open hours per day was 12.8 ± 3.9 h. The frequency of forced medication did not change, and the frequency of seclusion decreased significantly [χ2 (1, N = 131) = 4.73, p = 0.036]. CONCLUSION This pilot study underlines the potential of a change of door status to attain a reduction in safety measures in the first 4 months.
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Affiliation(s)
- Lisa Hochstrasser
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Alexander Voulgaris
- Abteilung für Psychiatrie und Psychotherapie, Justizvollzugskrankenhaus Berlin, Berlin, Germany
| | - Julian Möller
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Tatjana Zimmermann
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Regine Steinauer
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Undine E Lang
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Christian G Huber
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
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