Less Restrictive Seclusion Practices

Background

Patients being cared for in mental health services’ seclusion require regular physical health assessments to identify, prevent and manage clinical deterioration. Sometimes it may be unsafe or counter-therapeutic for clinical staff to enter the seclusion room, when that may involve a confrontation and possible restraint due to the patient's agitated state.

This makes it challenging to meet local seclusion standards for physical assessments. Alternatives to standard clinical assessment models are required in such circumstances to assure high quality and safe care.

The project

This project, led by Professor Sethi, aimed to improve the quality of physical health monitoring in seclusion by making accurate vital sign measurements more frequently available — without the use of restrictive practices.

Oxevision was installed in a mental health seclusion room and was used in addition to existing clinical care. Oxevision is a non-contact patient monitoring system that enables staff to measure pulse and breathing rate without entering the room and without any device being attached to the patient.

Over six months, adherence to local clinical guidelines whilst using Oxevision was compared against a time period prior to installation. Feedback was also sought from staff and patients through questionnaires and focus groups to explore the clinical experience of integrating a technological innovation within routine clinical care. A quality improvement framework was used to continually improve the process using plan, do, study, act (PDSA) cycles.

Progress

Results:
Oxevision enabled staff to obtain a 12.3-fold increase overall in the monitoring of physical health observations when compared to a real-world baseline rate of checks. Since the device is contact-free, staff could obtain vital sign measurements without entering the room and risking a confrontation and possible restraint. The technology thus supported staff in improving the quality and safety of care by increasing availability of physical health monitoring, without the use of restrictive practices. Enhancement to standard clinical care varied according to patient movement levels. Patients, carers and staff expressed positive views towards the technology.
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