Introduction:
SB 130 (Chesbro) relates to the use of seclusion and/or restraint of psychiatric patients. CPA
is opposing the bill unless it is amended to address certain concerns. While SB 130 implements
several recommendations of the American Psychiatric Association adopted in January, 2003, it also
contains some provisions that could jeopardize patient safety by dictating medical and nursing
practice. The bill describes seclusion and/or restraint as a treatment failure. However, it is a
safety measure, to be used only when needed to prevent harm to the patient or other persons,
including other patients, family members, and staff.
The APA position statement:
The American Psychiatric Association policy statement on seclusion and restraint recommends:
- "Encourage psychiatrists to support programmatic efforts intended to minimize the use of
restraints and seclusion and to ensure that, when such interventions are necessary based on
clinical judgment, they are administered safely by trained personnel.
- Encourage psychiatric programs, facilities, and systems to track restraint and seclusion rates
and to share research findings and clinical experience about best practices.
- Encourage psychiatric programs to follow up instances of use of restraint and seclusion with a
debriefing."
The provisions CPA supports:
SB 130 would implement the APA recommendations by providing the following:
- Calling for the Health and Human Services Agency to undertake efforts to reduce the need for
seclusion or restraint, collect data and provide training as funds become available.
- Providing for a system to collect meaningful data on the use of seclusion and restraint.
- Providing for initial assessment of a patient upon admission to a facility.
- Calling for facilities to conduct debriefings following an episode of seclusion and/or
restraint, a highly desirable practice.
All of these provisions focus on improving the quality of care. CPA supports them in concept and
is working to make them practical.
The bill had prohibited the use of medications to restrain a patient, but was recently amended in
the Senate Health Committee to adopt the federal rules on restraining with the use of medications,
which require a restraint to be the least restrictive method consistent with the safety of the
individual patient and others.
Remaining concerns:
SB 130 contains certain practice mandates that are cause for concern. The bill's findings, taken
as a whole, seem to assume that seclusion and/or restraint are never indicated, even though federal
regulations already require that seclusion and/or restraint may be used "only
when less restrictive measures have been found ineffective to protect the patient or others
from harm"... "implemented in the least restrictive manner possible; in
accordance with safe appropriate restraining techniques; and ended at the earliest possible time.".
The bill prescribes certain medical and nursing practices which should be left to clinical
judgment. These are:
- Placing significant legislative restrictions on the use of prone restraint, even though under
federal rules, this method of restraint is considered safe.
- Requiring a level of staffing probably available in hospitals, but not in some other
facilities covered by the bill.
- Limiting a physical restraint or containment to 10 minutes, without regard to what happens at
the end of the 10 minutes.
Reasons for CPA concerns:
The bill's prescriptive provisions on the nature and use of a containment or restraint do not allow
for progress in medical and nursing research or for the professionals in a facility to make clinical
decisions that they believe are the safest interventions for the individual patient. For example,
sometimes patients need to be restrained in a prone position to prevent aspiration or because they
have been traumatized in their earlier lives by a sexual assault. The length of time of a restraint,
or a seclusion should be the exact amount of time needed to calm the individual patient, and be made
by the clinicians involved using their professional judgment. Because they will limit options, they
could have the unintended consequences of increasing danger for the patient who is endangering self
or others, other patients and staff.
CPA wishes to work with all the interested parties to improve the safety of and lessen the need
to use of seclusion or restraint.
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