Abstract

Introduction: Violence, as a problem that has emerged in the workplace, particularly in areas such as emergency rooms and in psychiatric units, has a traumatizing effect for both patients and staff. Sensory Modulation as a therapeutic modality has high impact on patient and staff safety and also on patient experience. With its introduction to this inpatient adolescent psychiatric unit, the number of violent episodes was reduced, along with use of restraints. As the number of assaults of patient-to-patient and patient-to-staff has gone down, the number of staff compensation claims related to staff injury has also diminished. The initiative aligns with the organizations priorities of enhancing the quality of care and patient and staff safety.

Purpose: This Project provides an essential therapeutic modality for other health care organizations to consider in that it represents a “best practice” as well as a cost-effective method to assist psychiatric patients with self-regulation and self-management tools that they can use both in the units and after discharge. It is an evidence based practice (EBP) used by both patients with mental illness and those with developmental disability.

Study design, material and method: The facility’s method of self-study and needs assessment, a review of relevant literature and existing best practices on alternatives to use of restraints, led staff to come up with this pilot project. Initial results were very positive and the twofold goals of restraints reduction and decrease in assaults and fights were achieved. Since 2016, the results have been mostly consistent and ongoing for all of the adolescent patients. The transformation of a simple empty room to an easy to manage Sensory Room lends itself to opportunities to improve both the quality of service and safety of all the patients and staff. Staff was trained as to the use of the Sensory Room and then the modality introduced to the patients, either individually or in groups. Staff screens patients for voluntary participation. Registered Nurses interview patients for assessment and reassessment and observe them with regards to their responses to the modality.

With the increasing use of the Sensory Room, Activity Therapists and Nursing have also introduced the use of the Sensory Baskets as an enhancement to the Room. The basket contents include simple items such as rolls of bubble wraps, lotion with either lavender or cinnamon scent, markers with different scent of fruits, portable massagers, etc. Using PDSA (Plan, Do, Study, Act) model, we added metrics to the use of this modality, among which are: restraints use and number of assaults that occur in the unit.

Result: Using data to compare results after the initiation of the Sensory Modulation initiative, the hospital achieved Reduction in the use of restraints from 7.21 per 1000 patient days in 2016 to 3.62 per 1000 patient days in 2017. There is also a reduction in the number of assaults (patient to patient and patient to staff) from 4.54 per 1000 patient days in 2016 to 3.14 per 1000 patient days in 2017.

Conclusion: The program is ongoing and sustainable, utilizing cost effective resources-a room and a small dedicated budget to buy lost cost items for patient use of the Sensory Basket. The project has established a good track record, evidenced by the reductions in overall assaults and use if restraints from 2016 to 2017, in both raw total numbers as well as per 1000 patient days. The initiative has been replicated in the other adult inpatient units and has initial positive results in the reduction of assaults and fights as well as the use of intramuscular injections. Future studies are to be correlated to patients’ ability to apply the stress reduction modality learned from using Sensory Modulation.