587 - Staff Perception of Agitation, De-escalation, and Physical Restraint at a Children’s Hospital

Poster Number: 587
Publication Number: 587.126

Evan M. Dalton, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Diana Worsley, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Chris Feudtner, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Judy A. Shea, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Stephanie Doupnik, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Children with mental health conditions are frequently admitted to medical hospitals and may become agitated during their hospitalization. Teams of clinicians work to de-escalate these children, using physical restraint if less restrictive measures fail.

Objective: We sought to better understand the clinician work system factors that have a perceived impact on patient agitation, de-escalation, and physical restraint.

Design/Methods:

We used purposive sampling to identify clinicians who worked with children admitted for mental health conditions across different units at a quaternary care freestanding children’s hospital. We structured the analytic approach by examining five clinician work system factors related to agitation, de-escalation, and physical restraint: person, environment, tasks, technology and tools, and organization. We organized our interview guide using themes that aligned with components of an adapted Systems Engineering Initiative for Patient Safety (SEIPS) model (Figure 1). We conducted demographic surveys and semi-structured interviews with each participant until thematic saturation was achieved. Interviews were recorded, transcribed, and analyzed using a directed content analysis organized through NVivo.

Results:

40 clinicians participated in this study, including 21 nurses, 15 psychiatric technicians, 2 pediatricians, and 2 mental health specialists. Clinician work system factors specific to the medical hospital environment and tasks were perceived to be frequently agitating to children (Figure 2). Technology and tools helped clinicians de-escalate children, but the availability of certain toys and activities was limited. Organizational components such as teamwork and staffing were also perceived to be integral to the de-escalation process and differed between units based on unit resources and mental health experience. Clinicians’ personal beliefs about the indication for physical restraint varied across a continuum from ‘never’ to ‘often’ depending on the clinician’s perception of patient and clinician safety.

Conclusion(s):

Medical hospital environmental factors, individual clinician attributes, and characteristics of clinical teams all influenced patients’ agitation, de-escalation, and risk of physical restraint. To avoid the unnecessary use of physical restraint, future quality improvement initiatives can address these factors through multidisciplinary interventions.