Date of this Version


Document Type

DNP Project



Problem: Seclusion and restraint (SR) are techniques utilized frequently on inpatient psychiatric units to manage situations in which patients are an imminent threat themselves or to others. According to Joint Commission guidelines, SR is defined as the use of chemical, mechanical or physical methods, intended as a last resort, to control aggressive and dangerous behavior (Crisis Prevention Institute, 2010). Despite its intended use as a last option, SR is still commonly used on inpatient child and adolescent psychiatric units. Due to this incidence and the many negative consequences of SR, such as injury, death, or traumatization, its reduction on inpatient psychiatric units is an important clinical problem.

Background: The rate of SR on a child and adolescent psychiatric unit in a small psychiatric hospital in the Southeastern United States was much higher than was considered acceptable by their organization’s standards. Also, a review of the SR paperwork documenting these incidents over a two-month period found that the post incident debriefings were not being completed properly.

Method: A two-part debriefing system was implemented on a 44 bed child and adolescent inpatient psychiatric unit. This was accomplished through the use of an educational intervention on how to properly conduct and document a debriefing as well as the implementation of a second debriefing within 48 hours of the incident. Staff’s perception, gained knowledge, confidence, and willingness to change practice were assessed through the use of Likert scales before and after intervention. Chart reviews were also conducted before and after intervention to determine if there was an improvement in documentation.

Conclusion: Significant improvements were seen in staff perception of debriefing, confidence to perform a debriefing, as well as its importance post SR. Improvement was also noted in regard to documentation completeness and accuracy. Staff did not feel the intervention was effective in increasing their knowledge of debriefing practices overall, despite the intervention showing changes in practice.