Audit of Seclusion Practice in an Inpatient Adult Intellectual Disability (ID) Psychiatry Unit

Abstract

Aims

To investigate if current practice regarding the use of seclusion in an adult ID assessment and treatment unit was in keeping with the newly developed NHS Highland Seclusion Policy.

Methods

Case notes were reviewed for all patients who had had a period of seclusion between 20 September and October 2022.

Data were collected regarding the following:

• • Administration of seclusion (date; time started; medication used prior; reason for administration & duration);

• • 15 min interval monitoring (record of patient's mental & physical state including presentation, behaviour, conscious levels, respirations & appearance)

• • Review at 2 and 4 hours (including plans on how to end seclusion)

• • Documented Datix submitted and Monitoring of improvements.

Results

Thematic analysis showed that the most common reason for the use of seclusion was due to increasing agitation and aggression.

Data collection showed that the following information was missing from case records:

• • Use of anxiolytic before seclusion;

• • Under the 15 minute interval recording - respiration rate & appearance was missed most of the times;

• • Review at 2 hours: Plans to end seclusion was often missed; Review at 4 hours: on most occasions the duty consultant was not informed. They could give valuable insight and plans on stopping seclusion if it has prolonged more than 4 hours.

• • Datix was not sent every time seclusion commenced and this is needed as it would further provide to better identify and manage patients needing it.

Conclusion

Seclusion places people at risk. It is vital to ensure that there is robust monitoring of the patient's mental and physical state to reduce the risks associated with seclusion and, in particular, when medication which may lead to respiratory depression has been used. Seclusion should be used for the shortest time possible - explicit consideration of when and how to end seclusion provides an opportunity to limit the length of this highly restrictive intervention and minimise the impact on the person.

The results of the audit were shared with the staff team via the Seclusion Policy Short Life Working Group and will allow subsequent drafts of the service protocol to reflect good clinical practice. Results were also shared via the internal teaching programme and at the Clinical Governance forum. An additional session will also be provided during the induction plan for new trainees. Finally, a reaudit will be done to assess changes in seclusion practice.