"Sensory Modulation in an Inpatient Adolescent Psychiatry Unit"

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. COJ Nurse Healthcare Copyright © Jocelyn C Perez 2/4 How to cite this article: Jocelyn C P. Sensory Modulation in an Inpatient Adolescent Psychiatry Unit. COJ Nurse Healthcare. 3(5). COJNH.000575. 2018. DOI: 10.31031/COJNH.2018. 03.000575 Volume 3 Issue 5 and thought disorders, alcohol and drug addictions, and attention deficit hyperactivity disorder (ADHD), Conduct Disorders and other disruptive behaviors as well as grief and past abuse issues [1]. Patient assaults are the most common behavioral health category in most inpatient psychiatric settings and in large settings of care. It is a priority concern not only for its relative frequency, but for the scope and its effects on the course of treatment, care and safety of all patients and staff, their performance and work satisfaction. For purposes of this study, the term “assaults” as used in this 18 bed adolescent inpatient psychiatric unit, is defined by the New York State Office of Mental Health (SOMH) as “physical attack using force or violence in which a patient is either a victim or aggressor. Manual Restraints, as defined by SOMH, is the use of a manual or physical method to restrict a person’s freedom of movement or normal access to his or her body. The term “manual restraint”, means and includes the term “physical restraint”. This treatment modality of Sensory Modulation provides an essential remedy for other health care organizations 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 [2]. The use of Sensory Modulation supports a therapeutic, traumainformed culture of healing and recovery that meets the goals of significantly reducing the use of restrictive interventions such as restraints and seclusion; providing services that promote recovery, traumainformed and patient-centered care; and determining techniques or strategies that provides positive alternatives to restraints. With the impetus of further reducing the use of coercive interventions such as restraints, the hospital was awarded a small grant to transform an essentially empty room into a state of the art Sensory Modulation Room. The hospital’s primary goal is to provide a calming, relaxing space for patients and serve as an area where they can learn skills to self-regulate to decrease their anxiety and agitation, increase their functioning as well as life-long effective coping skills after discharge [3].