WILLIAM
OSLER
HEALTH
SYSTEM
Restraint Minimization
David Koczerginski MD FRCPC
Chief of Psychiatry
William Osler Health System
President AGHPS
November 9th, 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
 Restraint impact on physical health
 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
Balancing safety of patient, community,
staff
Acutely ill/psychotic/agitated/affectively
unstable patients.
Frontline “duty to detain”
WILLIAM
OSLER
HEALTH
SYSTEM
Restraint Minimization
Challenges
Inpatient focus on risk assessment,
treatment of psychosis, community and
patient safety with short length of stay.
Facility limitations
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
Culture change through
leadership/discussion/process
Data collection
Education/training programs
Optimizing staff and environment
WILLIAM
OSLER
HEALTH
SYSTEM
Restraint Minimization
Strategies
Emphasize the interdisciplinary team
Define the role of specialized Mental
Health RN’s
Debriefing/reviewing all restraint events
WILLIAM
OSLER
HEALTH
SYSTEM
Discussion
Mental Health Least Restraint Policies-reviews and
“standards”?
Observation and monitoring?
Re-ordering and 2nd opinions?
PRN restraint orders-mechanical and chemical?
Data collection and review?
Debriefing practices?
Education activity/restraint prevention?