Inpatient seclusion/restraint room

[nexus73]

Curious if having a seclusion/restraint room is standard on psych units. I've worked on about 7 different psych units across residency and attending work and they've all had some type of seclusion or restraint room, with exception of one high acuity ward with single rooms, and patients could be secluded in their own rooms.

Just curious is a seclusion room is standard part of an inpatient psych unit, or optional?

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[WisNeuro]

Curious if having a seclusion/restraint room is standard on psych units. I've worked on about 7 different psych units across residency and attending work and they've all had some type of seclusion or restraint room, with exception of one high acuity ward with single rooms, and patients could be secluded in their own rooms.

Just curious is a seclusion room is standard part of an inpatient psych unit, or optional?

They've been on all of my non-VA hospital units. Though my last hospital did not have one on each inpatient psych unit, only on the C-wing, where those deemed high behavior risk were housed.

 

[PsyDr]

SAMHSA made an overall policy in 2005 to eliminate seclusion rooms. Modern facilities are being constructed to eliminate seclusion rooms.

 

[whopper]

I've been out of inpatient for years, but I can't see why eliminating these type of rooms across the board is a good idea assuming the institution was utilizing them correctly. E.g. a 1% of patients in restraints die, so in Ohio if someone was in restraints, you want them in a room where they can avoid the stimuli of other patients distracting them, and the 1 to 1 can monitor the person uninterrupted.

I've worked in worst of the worst forensic units where patients were there for NGRI for murder, felonious assault, among other high risk violent offense. Further add to that the hospital then put the worst of these patients all in one unit. These were patients who were known to attack other patients or providers daily if not even more despite being on several high potency meds such as Clozapine, Lithium, Depakote, and add in 1-3 other meds. A seclusion room was vital for this type of situation.

I figure maybe there's some newer data I'm not aware of regarding seclusion rooms, or that this was someone's well-intentioned wish move that is oblivious to reality. (E.g. giving doctors more reimbursement for good patient reviews, of course no patient would give a doctor a better review for providing them with whatever drug of abuse they wanted. THAT WOULD NEVER EVER HAPPEN, and no doctor would ever ever ever give out a drug of abuse because a better review would mean more money. Never!)

 

[nexus73]

My hospital is wanting to convert the room we use for seclusion into a regular patient room to add one more bed to max census capacity

 

[SmallBird]

My hospital is wanting to convert the room we use for seclusion into a regular patient room to add one more bed to max census capacity

Eliminating seclusion rooms is a great opportunity for virtue signaling and only puts frontline caregivers at risk so really a no brainer for the 'leaders' who might be driving this.

 

[Sushirolls]

@SmallBird
Agreed. Just another virtue signaling symptom of greater societal decay.

Especially got to love the units that are open nursing stations, i.e. no place to retreat and patients can just hop over counters and grab access to all sorts of good weapons.

Or, only security on staff at night is 1 person, and geriatric. Then all the [female] nurses are only 5'2 and barely 100lbs, or they are 55yo+ and medically frail. So means you the doctor are pretty much the only person capable of doing patient take down, or whatever its Politically Correct called these days.

I personally know of 2 psychiatrists who have been attacked on garden variety gen psych units. One of which no longer does IP, and no desire set foot on IP again. Another only does IP now by telemedicine.

Seclusion, restraints, are a needed tool, and what marginal gain may be had for patient physical/life or emotional sequalae, doesn't fully weigh out the negatives to safety of staff, patient peers on unit, total morale of staff long term (i.e. burnout), or financial costs of patients tearing up nursing stations, or impressions of higher functioning patients on units who now say "no way in hell I'm ever going to a unit again" so their receptiveness for help seeking is permanently destroyed.

So then what happens, nursing staff has a quiet revolt - rightly so - for their safety.

• And "do not admit" lists emerge.
• And units starting screening for any signs of violence in possible transfer/admission, and they get denied because "lack capacity to accommodate or handle patient severity." So these patients then sit in their ED, adding to their pile of joy and rainbows down there.
• Then freestanding psychiatric/addiction hospitals owned by private equity type companies take an approach of "we'll accept everybody" and then they do, and then they churn thru their support staff and medical staff, baiting people in, possibly with higher salaries, only to quit after paying witness to their complete disarray. But hey, at least those units look great, and know how to market themselves to the local community!

Next, the ED docs, just B52, and once 'stable enough' discharge. Then places like Seattle, NYC, Portland, etc enhance their image as thriving, safe.

 

[Stagg737]

SAMHSA made an overall policy in 2005 to eliminate seclusion rooms. Modern facilities are being constructed to eliminate seclusion rooms.

Not really. Between med school (started in 2014) to now I've rotated through or worked in 8 psych units/hospitals, 2 of which were newly constructed and 2 more which underwent significant remodeling/reconstructing and every single one had at least one seclusion room. They don't call them "seclusion" rooms at every place anymore, but the purpose is still the same. Also, all 8 psych residency programs I interviewed at had seclusion rooms on their units, 6 of those were academic centers.

Call them whatever we want, but SAMHSA's policy was a recommendation that was out of touch with reality. Unless a unit only accepts the lowest acuity patients, many of whom don't need inpatient at all, seclusion rooms are unfortunately necessary for the safety of everyone, including the patient.

To the OP, I would not work on an inpatient unit that does not have a seclusion room unless there was a set up where every room could serve as a "restraint room". However, in those situations you'd have to put the patients on CO which could case staffing issues or have cameras in every room, which opens up several other issues.

 

[Sushirolls]

*Or that unit without seclusion is the 'high functioning' unit at a larger facility that is able to actually have different millieu for various units.

 

[comp1]

Definitely concur that if they are building new units without "seclusion rooms," they are just calling them something else. That said, I AM seeing open nursing stations being built which is horribly unsafe and should actually be prohibited. I read the SAMSHA brochure and I'm definitely not seeing any alternatives to seclusion. "Trauma informed care" does not stop the patient actively punching you because he's hallucinating and refusing medications. I also see a lot of confusing language in there about seclusion and restraint historically being considered "therapeutic." If by historically they mean 70+ years ago...maybe? I'm not even sure of that. Seclusion and restraints have been solely used in critical emergency situations to keep the patient and staff safe from harm when there are literally no other options. I certainly never heard anything else and none of the people I trained under heard of anything else. I also get a little frustrated that they lump seclusion in with restraint. They may both limit the patient's ability to move, but the dangers are quite different. Physical restraint does indeed carry a risk of death and it should only be used when the patient is actively putting themselves at a risk of harm that outweighs such a risk. Seclusion has risks, but they are significantly different.

 

[whopper]

Eliminating seclusion rooms is a great opportunity for virtue signaling

A local prosecutor in my area campaigned on reducing arrests and incarceration. So you figure it'd be by intervening by getting future criminals better diversions, education etc.

Guess what? She accomplished her goals by letting almost every person go without prosecution. One of those people who was constantly excused caused a girl to lose her legs. Despite this the very community she's supposed to protect had hold-outs who stated actions to remove her from office were "racist" despite that she literally wasn't doing her job and was working on a nursing degree while she was literally supposed to be in court.

'The evidence was so overwhelming': Missouri AG releases final report in investigation against Kim Gardner

Andrew Bailey is calling for tougher laws on holding public officials accountable and changes to Victims' Rights Act.

www.ksdk.com

 

[comp1]

I guess she fulfilled her campaign promises?