Publication/Presentation Date

7-25-2014

Abstract

Abstract

A restraint is considered a treatment failure due to the inability to calm the patient down prior to needing to use restraints. Restraints cannot only be traumatic to the patient and staff but it can cause psychological or physical harm. New alternative methods have become a treatment priority over the use of restraints. Sensory Rooms are being used in mental health settings to help with the development of positive coping mechanisms or de-escalation. Knowing from previous research that “the use of sensory modalities does reduce patient symptoms of emotional distress and that a reduction in restraint/seclusion rates requires a multi-faceted approach” (Green), I researched who all should be using the Sensory Room. I accomplished this by conducting chart checks to determine which patients met criteria for use of the room, and then of those patients that used the Sensory Room, was their feedback, positive or negative feedback after their visits. Between the fiscal years of 2013 and 2014 there was a 16.8% reduction in the number of restraint/seclusion episodes. In hope to reduce the number of restraint/seclusion episodes even more, the Sensory Room was opened to Behavioral health in June of 2014. Considering the newness of the Sensory Room, limited data has been collected but has had a positive impact so far.

Intro/Background

“A restraint is any manual method, physical, or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head freely; or a drug or medication when it is used as a restriction to manage the patient’s behavior/freedom of movement and is not standard treatment or dosage for patient’s condition.” (Lorenz) Restraints are used in certain situations. These situations would include if there is a risk of self-injury, a risk of injury to the staff or patient, and if the patient would prefer the use of the restraints. Aggressive behavior can lead to the use of restraints and varies from physical violence to verbal aggression. Acts of aggressive behavior could be considered intimidating posture, threats or acts to harm someone or themselves, destruction, throwing of objects, invading personal space, verbal abuse, and yelling loudly usually in an angry tone. To reiterate, the use of restraints is considered a treatment failure because the patient could not be calmed down prior to the need for restraints. The use of restraints cannot only be traumatic to the patient and/or staff, but it may escalate the situation even more instead of providing de-escalation, and can also cause psychological and physical harm. The use of sensory modalities in mental health settings is being utilized as an alternative way to assist patients with positive coping mechanisms instead of restraints. These sensory modalities pertain to all five of the senses: auditory, olfactory, visual, gustatory, and tactile. This is where a Sensory Room would come into picture. “A sensory room is an umbrella term used to categorize a broad variety of therapeutic spaces specifically designed and utilized to promote self-organization and positive change.” (Occupational Therapy Innovations) These quiet rooms are designed for the purpose of prevention and de-escalation of a patient supported by the use of their senses. My mentor Colleen Green researched the question “will the use of sensory modalities by adult inpatient psychiatric patients reduce their aggression and/or anxiety to the point where we see a reduction in the use of restraints/seclusion during hospitalization?” She came to the conclusion that “the use of sensory modalities does reduce patient symptoms of emotional distress. A reduction in restraint/seclusion rates requires a multi-faceted approach.” (Green) My research further expands on Ms. Green’s research, by determining who can use the Sensory Room and ensuring that the patients who meet the criteria for use of the room are utilizing it.

Methods

Behavioral Health recently opened a new Sensory Room to patients. The very first part of my research was to get familiar with the Lehigh Valley Health Network’s Sensory Room. I was not only showed the room, but I was taught all the rules and what the room all entitles. Some of the rules include: patient limited to 20 minutes in the Sensory Room, to sign in and out during each visit, patient must be accompanied by a validated staff member, no food or drink in the Sensory Room, and to provide feedback on the visit before leaving the room. As mentioned before, the sensory modalities assist to each of the five senses. Therefore, Lehigh Valley Hospital’s Sensory Room has “activities” linked to each sense. Auditory had a sound machine and music CD’s for the patient to choose a preferred sound. Olfactory had scented lotion to massage into their hands and scented cards with different aromas, for example lavender for a calming effect. Gustatory had herbal teas and hard candy that can be used as a grinding technique (staff must be aware of medical conditions for example diabetes for the candy). Visual had an electronic fish aquarium, DVD’s, positive affirmations or quotes, and special lighting in the room that can change colors or stays a certain color depending on the patient’s mood. Tactile had hand-held manipulative items that include Panic Pete, Bendeez, stress balls, sparkle wheel, glitter bead ball, scented and unscented bean bags, and ultimate spaghetti fidget; and weighted items that include an animal, vest, lap pad, and blanket. Lastly, there are focused activities like crossword puzzles, word searches, coloring pages, and Kanoodle puzzles. After learning the specifics about the Sensory Room, I had to know who was allowed to use the sensory room. There are five different phases of patient escalation. Phase one: Calm/Pre-Anxiety means the patient has relaxed muscles, low tension, appears happy/content, able to engage in milieu, focus on task, and easy to engage. Phase two: Anxious means the patient has the same characteristics as phase one. Phase three: Defensive means the patient has increased muscle tension, glaring, tremulous/flushed, angry/irritable, negative/fearful, pacing/intrusive, challenging/threatening, and swearing. Phase four: Acting Out means the patient is posturing, intense staring, absent eye-blink, hostile, irrational, cared/paranoid, yelling/screaming, throwing things, and physical violence. Phase five: Tension Reduction means the patient is restless/jittery, exhausted/tired, cold/sweating, tearful/crying, withdrawn, panicky, laying down, fidgety/rocking, and low tolerance for environmental stimuli. In phases one and two the patient may utilize the Sensory Room, phases three and five the patient may utilize the Sensory Room only based on staff judgment, and in phase 4 the patient is in an active volatile state and is NOT allowed to use the Sensory Room. Having all the information about the Sensory Room I read through the patients’ charts on BH1 to see who the candidates are to use the Sensory Room. I used the 5 phases to determine who was a candidate. Also, anyone exhibiting aggressive or violent behavior or too confused they cannot partake in the milieu are not appropriate candidates for the Sensory Room. After the chart checks, I followed up in the Sensory Room checking the log book and patient cards to see how many patients and who is utilizing the room along with checking for positive or negative feedback.

Results

During Behavioral Health’s fiscal year of 2013, there were 380 restraint/seclusion episodes and during the fiscal year of 2014 there was a decrease to 316 restraint/seclusion episodes. Therefore, between the fiscal years of 2013 and 2014, there has been a 16.8% reduction in restraint/seclusion episodes. In hope to continue the reduction of restraint/seclusion episodes, the Sensory Room was opened in June of 2014 for Behavioral Health. Putting into consideration that the Sensory Room is very new to Behavioral Health, not much data has been provided and collected. Being somewhat short staffed during times also prevented the ability for staff to bring patients into the room. For the handful of patients and staff that did fill out the patient cards with feedback about the patient’s visit, each one had a positive affect and experienced de-escalation. As of July 16th, since the Sensory Room opened in June, there have been 19 visits to the room. For the month of June: there were 14 visits (last 3 weeks of June). One visit was for orientation, two visits for anger, four visits for anxiety, and seven visits for relaxation. For the month of July: there were 5 visits (up to July 16th). Two of the visits were for orientation to the room, two of the visits were for anxiety relief, and one visit was for relaxation. The two visits for anxiety were by the same patient. The first time the patient used the room; they entered the room with their anxiety level at an 8 and left the room with their level at a 4. The second time that patient used the room, they entered the room with their anxiety level at a 7 and left with their level at a 6. The patient visiting for relaxation entered the room at a 5 and left the room at a 4.

Conclusion/Discussion

Based on the scarcity of results collected on the Sensory Room, further research is need over a longer period of time. It is hope that the use of the Sensory Room will lead to a completely restraint free environment. The Sensory room encourages patients to become involved in developing/identifying coping mechanisms and de-escalation techniques for use not only on the unit but also after discharge. In the continuation of the room, there is a hope to continue the increase in utilization of sensory items as the means of patient de-escalation. Another research project that would stem from this project could be researching the use of sensory modalities after the patient is discharged to see if patient experiences in the “Sensory Room” provide long term results for emotional regulation.

Comments

Marissa Saeger, Temple University.

Mentor: Colleen Green

Department(s)

Research Scholars, Research Scholars - Posters

Document Type

Poster

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