physical-or-mechanical-restraint-use-in-acute-MHA

INDICATOR NAME

Name

Use of physical or mechanical restraints in facilities providing acute mental health care

Alternate Name

Percentage of mental-health-bed hospitalizations in which physical restraints were used

INDICATOR DESCRIPTION

Description

This indicator measures the percentage of patients in mental-health-designated beds in Ontario who had an indication of the use of a mechanical or physical restraint in their Ontario Mental Health Reporting System record.

Indicator Status

Active

HQO Reporting tool/product

Public reporting

Dimension

Effective

Type

Process

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

This indicator is calculated as: the numerator divided by the denominator, multiplied by 100.

Numerator including inclusion/exclusion

Patients who had the following restraint use indicated on their OMHRS records:

Mechanical restraint use (M1A greater or equal to 1)
Chair prevents rising (M1B greater or equal to 1)
Physical /manual restraint by staff (M1C greater or equal to 1)

Denominator including inclusion/exclusion

Total number of individuals who were discharged from a designated adult mental health bed in an Ontario hospital

Inclusions:

Patients with records in OMHRS
Assessments with variables M1A, M1B and M1C
Valid OHIP number

Adjustment (risk, age/sex standardization)- detailed

Age- and sex-standardized to the 2006 Ontario census population

Data Source

Ontario Mental Health Reporting System (OMHRS), Registered Persons Database (RPDB)

Data provided to HQO by

Institute for Clinical Evaluative Sciences (ICES)

Reported Levels of comparability /stratifications (defined)

Age, Income, Region, Sex, Time

OTHER RELEVANT INFORMATION

Caveats and Limitations

Control interventions in OMHRS are reported in full assessment records which typically occur at set intervals and may not capture information about incidents that occur between intervals. This is related to the fact that there is no reporting requirement for control interventions and, therefore, in instances where hospital stays are longer, a larger number of control interventions may go unreported.The analysis was limited by the exclusion of individuals with hospital stays of three days or less. Short-stay RAI-MH assessments do not require all data elements to be coded.

Comments Detailed

OMHRS data elements: • Mechanical restraint use (M1A) • Chair prevents rising (M1B ) • Physical /manual restraint by staff (M1C)

Footnotes

1 R. Almvik et al., "Challenging Behaviour in the Elderly-Monitoring Violent Incidents", International Journal of Geriatric Psychiatry 21, 4 (2006): pp. 368-374. 2 W. A. Fisher, "Restraint and Seclusion: A Review of the Literature", American Journal of Psychiatry 151, 11 (1994): pp. 1584-1591. 3 Government of Ontario, Patient Restraint Minimization Act, 2001 (Toronto, Ont.: Government of Ontario, 2001). 4 Government of Ontario, Mental Health Act (Toronto, Ont.: Government of Ontario, 2001). 5 Government of Ontario, Health Care Consent Act, 1996 (Toronto, Ont.: Government of Ontario, 2010). 6 Restraint use and other control interventions for mental health inpatients in Ontario. August 2011. Accessed on 01.05.2014 at https://secure.cihi.ca/free_products/Restraint_Use_and_Other_Control_Interventions_AIB_EN.pdf 7 Gilmer PD. Adherence to Treatment With Antipsychotic Medication and Health Care Costs Among Medicaid Beneficiaries With Schizophrenia. Am J Psychiatry 2004 8 Practice standards. Restraints. College of Nurses in Ontario. 2009