Section 2 is about the prevention of adverse events that occur during seclusion and restraint for aggression and violence among patients. There are risks in seclusion and restraint. Restraint-related injuries and deaths was at 7th in the types of events reported to the Joint Commission between 1995 and 2005. And according to the Joint Commission, the leading causes of seclusion and restraint injury or death include asphyxiation, strangulation, cardiac arrest, or what would happen to a patient if there was a fire. What we're interested in is how to look at these problems from the patient safety quality improvement perspective. Well, from in terms of asphyxiation, avoidance of restraining a patient in the prone position, monitoring for asphyxiation, awareness that patients with deformities are at risk, avoidance of placing objects near the patient's face, avoidance of any obstruction of the airway. These are methods that have been learned over time through experience, perhaps through root cause analyses or other methods. In terms of strangulation, awareness of strangulation risks for geriatric patients, especially those who are in vest restraints, monitoring when there might be unprotected side rails, and awareness that patients with deformities also can have problems with strangulation, are important tools to prevent these adverse events from occurring during restraint or seclusion. In terms of cardiac arrest, monitoring of patients who are in restraint is important, and their medical status needs to be assessed as well. One should remain alert for signs of cardiac arrest. In terms of fire, one should have awareness that patients who smoke, especially male patients, are at high risk for fire deaths. This may occur less and less in hospitals in the United States today, but it certainly can occur in settings where smoking is allowed, whether that's an inpatient or an outpatient setting. Overall then, a patient safety approach to decrease the use of seclusion or restraint will also be important for reducing deaths and injuries, and that can occur through organizational culture, training, continuous quality improvement, the development of alternatives to restraint, and improvements in assessment. And so these different approaches are to be seen in concert with traditional approaches to prevent injuries and deaths for patients who are in restraint or seclusion. For more information, please visit www.FEMA.gov.

adverse events

seclusion

restraint

aggressive patients

violent patients