Management of patients kept in Seclusion

Seclusion is the supervised confinement of a patient in a room which may be locked to protect patient/s and/or others from significant harm. Its sole aim is to contain severely disturbed/violent behaviour that is likely to cause harm to others.

Seclusion stay may constitute an imposition on a person‘s rights and dignity and should only be used as a last resort for the shortest possible time and for the purpose of promoting and maintaining a person‘s health and wellbeing, or in the short term, the health and wellbeing of others. Seclusion should not be used as a punishment or threat; as part of a regular treatment programme or because of shortage of staff. In certain circumstances when other measures have failed seclusion may be used. Seclusion of a Voluntary patient for a short period per say does not warrant consideration for a temporary detention.

If ward Nursing Officers on duty decide that staff or patients are at risk of violence and de-escalation techniques have failed to calm the patient, then they may put the patient in seclusion. Once secluded the following steps should be followed. 1. The On Call Medical Officer should be notified immediately and they should come and assess the patient and consider rapid tranquilization or duration of seclusion stay 2. A note must be made in the BHT by Nursing Officers and Medical Officer 3. Nursing Officers should inform to Special Grade Nursing Officers in their routine reporting system 4. Medical Officers need to keep the Consultant/ Senior Registrar updated

1. A trained Nursing Officer should be observing the seclusion physically or via CCTV at all times within close vicinity. Provision should be made to over breaks and shift handover of Nursing

Officers.

2. Support Staff should be available to assist if required. 3. A Seclusion Register entry should be commenced as soon as patient is admitted to seclusion 4. A full review should be carried out if a patient is to be secluded for more than 02 hours 5. A Nursing Officer should physically review the seclusions every 02 hours with the assistance of a

Support Staff

6. A Medical Officer should routinely review the patient every 08 hours with accompaniment of the

Nursing Officer and Support Staff and more frequently if need arises. 7. Any secluded patient kept in seclusion for more than 12 hours needs to be reviewed by the

Consultant/ Senior Regitar 8. If rapid tranquilization is given and sedation is setting in patient should immediately be moved to a observation bed for monitoring 9. Highly suicidal patients should be best avoided from seclusion stay

1. Should be well lit and ventilated

2. Patients should be kept separated from other patients 3. Patients should have minimum furniture on case by case basis unless they are likely to harm themselves or damage it 4. Patient should be able to call for help from Nursing Officers or Support Staff 5. Tear proof clothing and blankets should be provided if possible 6. Food and Water or other drinks should be provided regularly and toilet and washing facilities should be provided on request 7. All articles which are potentially dangerous should be removed