Real Reduction Experiences

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Creating Violence Free and Coercion Free Service
Environments for the Reduction of Seclusion and
Restraint

• Real Reduction Experiences
• What Worked?

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Real Reduction Experiences
Kevin Huckshorn, MSN, RN, ICADC Former CNO and
Assistant Hospital Administrator, ASH/SFSH

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South Florida State HospitalFacility Profile

• Adult State Mental Health Facility
• First, fully privatized in the country (11/98)
• 325 beds Average Daily Census 275
• Average Length Of Stay
• 220 days since privatization
• 3 years (all residents)
• Primary Diagnoses schizophrenia, major
  depression with psychosis, schizoaffective
  disorder

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South Florida State HospitalFacility Profile

• 45 of residents have been involved with criminal
  justice system.
• 95 of residents are involuntarily committed, or
  court ordered.

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South Florida State HospitalInitiative

• Seclusion/restraint reduction initiative started
  in November 1999.
• During ASHs first year of operation a total of
  264 seclusions and 197 restraints were
  administered.
• Since May 2002 there has been only 1 seclusion (gt
  hour) and 5 restraints.

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South Florida State HospitalStrategies

• Decision made by executive management group (EMG)
  after CEO attended a NASMHPD conference and
  learned about PA initiative.
• No additional money, no consultants, no external
  training, no additional staff.

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South Florida State HospitalStrategies

• Change in aggression control training model.
• Converting CPI (Crisis Prevention Institute) to
  NAPPI (Non-abusive Psychological Physical
  Intervention) training and certification with
  primary emphasis on staff to persons served
  relations and assessment and response to
  behaviors.

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South Florida State HospitalEssential Components

• Full support and oversight by CEO/COO.
• Strong policy statement and revised policies and
  procedures.

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South Florida State HospitalEssential Components

• Use of data, graphed and posted for unit
  comparisons.
• Debriefing including root cause analysis (RCA)
  and daily reports to EMG non-punitive
  environment.

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South Florida State Hospital Essential
Components

• Change in staff roles (security, nursing, direct
  care staff).
• Supervisors responding to every incident on call
  EMG member involved for oversight 24/7.
• Use of persons served throughout project
• interview residents and staff
• make recommendations
• comfort rooms.

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South Florida State Hospital Essential Components

• Project placed on every meeting agenda.
• Staff encouraged and acknowledged.
• Town Center programming implemented.

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SECLUSION AND RESTRAINT RESULTS January 1999 -
March 2004
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RESULTS
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RESULTS
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EMERGENCY INTRAMUSCULAR INJECTIONS MAY 2001-
MARCH 2004
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RESULTS
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CHALLENGES

• Resistance

• Training

• Resources

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South Florida State HospitalKey Contact

• Debra Kirsch, MD
• Clinical Operations Director
• Atlantic Shores Healthcare, Inc./
• South Florida State Hospital
• 800 E. Cypress Drive
• Pembroke Pines, FL 33025
• [phone]
• dkirsch_at_sfsh.org