East London Modified-Broset as Decision-Making Tool to Predict Seclusion in Psychiatric Intensive Care Units

Frontiers in Psychiatry

Karl Marlowe¹  Felice Loi² 

[1] Centre for Psychiatry Queen Mary University of London, London, United Kingdom;Juniper Court Churchill Hospital CAS Behavioural Health, London, United Kingdom;Millharbour PICU Mile End Hospital East London NHS Foundation Trust, London, United Kingdom;

关键词: behavior;    coercion;    decision-making;    prediction;    seclusion;    violence;   

DOI  :  10.3389/fpsyt.2017.00194

来源: DOAJ

【 摘 要 】

Seclusion is a last resort intervention for management of aggressive behavior in psychiatric settings. There is no current objective and practical decision-making instrument for seclusion use on psychiatric wards. Our aim was to test the predictive and discriminatory characteristics of the East London Modified-Broset (ELMB), to delineate its decision-making profile for seclusion of adult psychiatric patients, and second to benchmark it against the psychometric properties of the Broset Violence Checklist (BVC). ELMB, an 8-item modified version of the 6-item BVC, was retrospectively employed to evaluate the seclusion decision-making process on two Psychiatric Intensive Care Units (patients n = 201; incidents n = 2,187). Data analyses were carried out using multivariate regression and Receiver Operating Characteristic (ROC) curves. Predictors of seclusion were: physical violence toward staff/patients OR = 24.2; non-compliance with PRN (pro re nata) medications OR = 9.8; and damage to hospital property OR = 2.9. ROC analyses indicated that ELMB was significantly more accurate that BVC, with higher sensitivity, specificity, and positive likelihood ratio. Results were similar across gender. The ELMB is a sensitive and specific instrument that can be used to guide the decision-making process when implementing seclusion.

【 授权许可】

Unknown