A Pilot Study to Evaluate the Effects of Utilizing the LOWLINE Model in Decreasing the Frequency of Physical Restraints on Emotionally Dysregulated Patients in the Mental Health Setting (Preprint)
Authors: Llamas Jonathan 
Published: August 2020

BACKGROUND

For many nurses, knowing how to handle and de-escalate aggressive patients effectively is not a trait that comes second nature. In the past decade or so, violent incidents have increased 110 percent among healthcare workers and are four times more likely to occur in healthcare than in any other private industry (OSHA, 2015). Although nurses are often called upon to handle stressful situations effectively, many nurses feel anxious and unequipped to safely de-escalate aggressive and hostile patients successfully. Because of this unfortunate reality, Lowry et al. (2016), conceptualized a new theoretical practice model called the LOWLINE Model that educates nurses and other healthcare professionals on how to safely manage and de-escalate hostile and aggressive patients in the clinical setting.

OBJECTIVE

The goal of this evidence-based quality improvement project was to evaluate the effects of utilizing inpatient staff education on the LOWLINE Model to determine if the frequency of physical restraints on emotionally dysregulated patients in the mental health setting would decrease over a three-month span.

METHODS

Utilizing an evidence-based practice (EBP) process, an intensive education class was implemented to teach nurses new de-escalation skills and techniques based on the LOWLINE model. The implementation consisted of a two-day training session that accommodated all shifts (AM, PM, and NOC) and lasted approximately one hour. During the training session, the class went in depth on learning how to identify and recognize possible signs and tendencies in potentially aggressive patients and how to safely de-escalate their behavior. To determine overall efficacy, a PDSA process was enforced and statistical data on restraint rates were collected, assessed, and analyzed through the organization’s LOWLINE staff debriefing forms and unusual occurrence reporting (UOR) system.

RESULTS

After successfully completing the intensive staff education class, quantitative results indicated an increase in nursing knowledge of the LOWLINE Model among all participating staff that attended (14 nurses) with an average score of 95% on the posttest questionnaire. The amount of physical restraints utilized also decreased by 16% from 32 incidents to 27 incidents in Unit 1 (pilot unit) over the course of a three-month span. Most importantly, detailed analysis and evaluation of the LOWLINE staff debriefing forms revealed that 30 restraint episodes were prevented by nurses who utilized the de-escalation skills and techniques taught in the LOWLINE Model.

CONCLUSIONS

Although broader implementation and further research is necessary, teaching nurses innovative de-escalation techniques like the LOWLINE Model can prove to be efficacious in not only reducing the amount of physical restraints used but also preventing potentially violent incidents from occurring. Therefore, since agitation is an acute behavioral emergency that requires immediate intervention, nurses and allied health professionals must be educated and prepared to utilize de-escalation techniques effectively to promote continuous patient safety and staff protection across the healthcare spectrum.

CLINICALTRIAL

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