By James Rioux, Director of Classification and Treatment
The reduction of patient seclusion and restraint is a national safety goal in psychiatric facilities, both private and public, including at Bridgewater State Hospital (BSH). In an effort to meet this national safety goal BSH staff have received specialized training in trauma and de-escalation techniques; increased our crisis coverage; developed individualized de-escalation plans for each patient; created the A-1 Step Program (featured in the ATB newsletter on 12/14/15), and re-purposed areas to create therapeutic environments on each unit called Quiet Rooms and Comfort or Sensory Rooms to reduce patient seclusion and restraint.
In early 2015, two Performance Improvements Teams, composed of a multidisciplinary team of professionals were formed to develop the protocols, physical space, and inventories for these two therapeutic environments. From February to May 2015 Quiet Rooms were established at BSH to serve as an intervention when a patient is demonstrating signature signs of distress and/or clinical deterioration. For example, the patient might be experiencing auditory hallucinations and may benefit from listening to the walk-man which may prevent his symptoms from rising above a baseline level of distress. Patients already presenting with higher levels of stress from their baseline may benefit from use of the Quiet Room in an effort to prevent further escalation of symptoms and avoid subsequent admissions to the Intensive Treatment Unit. They may also be used by patients to manage every day anxiety related to their incarceration or hospitalization. Quiet Rooms are specifically designated on each unit and can be voluntarily used Monday thru Friday or when indicated by a crisis clinician and discontinued by the patient at any time. Use of the room will also be discontinued if a patient demonstrates a serious threat of extreme violence, personal injury or attempts suicide. Quiet Rooms can only be occupied by one patient at a time. All Quiet Rooms are equipped with a chalkboard, TV, sound machine, rocking chair, noise reducing headphones, desk and stool.
In October of 2015 BSH introduced Comfort Rooms in several of the housing units. They currently serve as an additional clinical intervention to moderate clinical symptoms, reduce the use of seclusion and restraint, and further improve the environment of care for patients at BSH. Comfort Rooms are used as both an incentive for patients engaging in their recommended treatment plan and a privilege based on the needs of the unit population. Comfort Rooms can be utilized Monday thru Friday and are available in the minimum units. Prior to use, the Treatment Staff will assess each patient based upon their risk and treatment plan compliance and assign them a ‘Privilege Level’. For instance, patients who are designated Privilege Level 1 must maintain medication compliance and behavioral stability, participate in treatment planning, and attend at least one group on or off unit per week in order to utilize the TV, audio station, or projector. Comfort Rooms can be occupied by a maximum of four patients at one time but they must all be assigned to the same privilege level. Similar to Quiet Rooms, Comfort Rooms offer de-escalation items aligned with a patient’s de-escalation track. For example, a patient who benefits from an ‘Expressive’ de-escalation track can access markers, velvet art, and a soft keyboard while a patient who selects a ‘Sensory’ track can access stress balls, aroma therapy, and a Chair Massage topper. Patients who are designated as having the most privileges (Privilege Level 3), are able to utilize the Nintendo 3DS, which is considered an ‘Interactive’ de-escalation track.
Since the creation of the Quiet Rooms in May of 2015 and Comfort Rooms in October of 2015, there has been a 26% reduction in patient seclusion events and a 16% reduction in patient restraint events at BSH (when compared to the same time period in 2014). BSH extends its appreciation to everyone who contributed to the creation of our Quiet and Comfort Rooms and to those staff members who are actively involved in the management of these therapeutic environments for patients.