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Restraint (seclusion?) room location

By Maureen Kolomeir posted 02-11-2010 04:07 PM

  
Is this room also used as a quiet room and/or a seclusion room? Because if it is only for restraints, then it is best located close to the nursing station. In my experience, most patients in the milieu do not want to be near a restraint /seclusion room.

Consider these factors:

What is the route of transport for the patient being accompanied to the restraint room?
If the route is through the nursing station or charting area or offices, and the patient is NOT in restraints while being escorted, then there is the chance that the patient might break free and access items that could be used to harm (self or others).

You need to be able to view AND hear the patient for the first hour if seclusion, and all the time if restraints. So staff proximity is important unless you have an inside-the-room camera. Even so, it the room is purely for restraints, then it needs to be W/I earshot, unless you have a dedicated sitter at all times.

Where I worked (I recently left) we reduced the use of restraints to -maybe-one every 14 months, prolly even less. We used seclusion and even that use went down. So I am not that familiar with restraints, and as such, haven't heard the term "restraint room" used in a long while. Can I make a suggestion - think about renaming the room to quiet room or seclusion room . Our patients hear a lot and the term restraint room can be frightening. I know I would be frightened if I heard it on the "other side" of the nursing station.

Caveat: Make sure your dimensions are the right height. Grilles/vents safely out of reach. I've seen this problem crop up before. Consult The Built Environment for Behavioral Health. Your Director of Maintenance and or Security should be able to access this BH physical plant guidebook, referred to by both the JC and the CMS. 
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Leighton Kennedy
02-16-2011 11:49 AM

Helen,
I love the idea of individualized naming of rooms in order to step away from the stigma of restraint and coercion. I've been the director for two adolescent psychiatic units and had to challenge the perceptions of restraint and coercion, by removing the restraint and seclusion prompter and infusing more preventative strategies. We removed the restraint rooms/quiet rooms (phase out mechanical restraint in practice and policy) and implemented sensory rooms/areas, individualized sensory diets, and transitional bedrooms. The idea of having a timeout room for teens felt coercive for the youth since they have had some traumatizing experiences with "timeouts". Timeouts were perceived as involuntary aka seclusion so we stayed away from certain terminology that prompted a coercive perception. Transitional bedrooms were the old restraint rooms that became basic bedrooms (bedframe and mattress) used as temporary place for youth to sleep for the night. The person in charge and other staff would offer a few safe items of the youth's personal preference (sensory items or personal) that were not deemed a risk for the person. The youth would be able to leave that room but would be excluded areas that were deemed too high risk. The person in charge, the doctor, and any other team member available would determine their level of observation based on assessment with the client. Many factors would be taken into account include environmental risks, interpersonal factors, ability to self regulate, engagement in treatment, etc. We tried to provide the dignity of risk and respect through have a youthdriven, family guided, collaborative, trauma informed approach. This approach has work well for those programs.
This is what seemed to work for my programs, but every environment would have to choose how they can step further away coercive practices like labeling areas in the environment after our coercive practices.
By the way Helen I love the idea of the room moving across from the nursing station so that the staff didn't have to sit in the room.
I sure wish though that our environments could progress with our ideas. Some environments create a real challenge.

Helen Farrar
03-18-2010 03:35 PM

Maureen, I appreciate your comments. I agree that the term "restraint room" would be off putting and also may lend to a comfort with restraints on the part of staff. I think it is important to ask what purpose the room may serve for your individual unit and then tailor the location and label term for your area. For example, many ped pysch units use these rooms as "time-out" areas to assist patients to de-escalate themselves free of stimuli but they are not necessarily "restrained" there. For these situations a different room is used similar to a hospital type pediatric "procedure room" so that no painful procedures happen in their assigned rooms.
For geriatric psych we have elected to have our room across from the nursing station and within easy resource of the other caregivers so avoid having a staff at the end of a hall observing the patient within the room.
Those are just my ideas, great discussion and thank you for mentioning the BH physical plant guidebook as I was not aware of that resource.
Helen