An examination of the incidence and nature of chemical restraint on adult acute psychiatric inpatient units in Adelaide, South Australia

• Published in: International journal of mental health nursing 2019-08, Vol.28 (4), p.909-921
• Main Authors: Hu, Feyan, Muir‐Cochrane, Eimear, Oster, Candice, Gerace, Adam
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Antipsychotic Agents - therapeutic use; Behavior disorders; Benzodiazepines - therapeutic use; chemical restraint; Coercion; coercive measures; Conscious Sedation - methods; Conscious Sedation - statistics & numerical data; Consumers; Delusional disorder; Drugs; Female; Humans; Hypnotics and Sedatives - therapeutic use; Incidence; Inpatient care; Male; Mental disorders; Mental Disorders - therapy; Middle Aged; Nursing; Olanzapine; Psychiatric Department, Hospital - statistics & numerical data; Psychiatric services; Psychiatric units; Psychotropic drugs; restraint; Retrospective Studies; Schizophrenia; Sex Factors; Side effects; South Australia; Young Adult
• ISSN: 1445-8330; 1447-0349
• DOI: 10.1111/inm.12591

Reducing and/or eliminating the use of coercive measures in psychiatric services is a priority worldwide. Chemical restraint is one such measure, yet to date has been poorly defined and poorly investigated. The aim of this study was to examine chemical restraint use in 12 adult acute inpatient psychiatric units in Adelaide, South Australia. Methods involved the analysis of all reported chemical restraint events occurring over a 12‐month period analysed using a descriptive quantitative design. There were 166 chemical restraint events involving 110 consumers. The highest prevalence rate in an individual unit was 28.78 events per 1000 occupied bed days, with the lowest being 0.12 events per 1000 occupied bed days. More males (n = 69, 57.5%) were involved in chemical restraint than females. Schizophrenia, schizotypal, and delusional disorders were the predominant diagnoses among consumers who were chemically restrained. The most events occurred during three time blocks: 14.00–14.59 pm, 16.00–16.59 pm, and 21.00–21.59 pm. The two most common medications used were olanzapine and clonazepam. The study presents a general picture of the practice of chemical restraint in Adelaide and identifies areas of concern in relation to the need for monitoring of side effects and completion of systematic processes of documentation regarding chemical restraint events. Findings highlight the need for sustained focus on reducing the need for chemical restraint and exploring less restrictive measures with those most likely to receive medication against their will.