Audit of the use of Seclusion in an Approved Centre following introduction of an Integrated Care Pathway

Introduction: The Mental Health Commission (MHC) has published guidelines on the rules governing the use of seclusion. These must be followed and the use of seclusion recorded in the patient’s clinical file during each seclusion episode. We devised a Seclusion Integrated Care Pathway (ICP) for use in the Approved Centre in Tallaght Hospital, Dublin, Republic of Ireland. This document was developed in conjunction with the MHC guidelines to assist in the recording and monitoring of each seclusion episode. Methods: The MHC has listed 13 rules governing the use of seclusion. These include the responsibility of the registered medical practitioner (RMP), nursing staff and the levels of observations and frequency of reviews that must take place during each seclusion episode. Using the seclusion register we identified a total of 60 seclusion episodes; 30 prior to the introduction of the ICP and 30 following the introduction of the ICP. We conducted a retrospective chart review to assess the documentation of each seclusion episode. The purpose of this audit was to compare adherence to MHC codes of practice on the use of seclusion before and after the introduction of our ICP. Results: There was overall improvement in adherence following the introduction of the ICP. Areas of improvement included consultant notification, informing the patient of the reasons for and likely duration of seclusion, informing the next of kin, 15 minute nursing observations and 2-hourly nursing review. Medical reviews within 4 hours, documentation of whether seclusion could be discontinued and subsequent medical assessment disimproved following introduction of the ICP. Conclusion: While an ICP is a robust document and ensures that many of the rules in relation to seclusion are explicitly stated adjustments to the document and regular staff training are needed to ensure full adherence to MHC guidelines.