Relationship between nurses' use of verbal de-escalation and mechanical restraint in acute inpatient mental health care: a retrospective study.

Although the use of verbal de-escalation in nursing has been shown to be an effective tool for controlling agitation and avoiding mechanical restraint, there is scarce evidence supporting the use of de-escalation by nurses and factors related to the patients who ultimately receive mechanical restraint. This retrospective study sought to examine the relationship between the use of verbal de-escalation by nurses and the clinical profile of patients who had received mechanical restraint at an acute mental health unit. This study analysed the records of patients who had received mechanical restraint between the years 2012 and 2019. A bivariate analysis was initially performed, followed by multiple logistic regression analysis. A total of 493 episodes of restraint were recorded. Of these, in almost 40% of cases, no prior use of verbal de-escalation was noted. The factors associated with the use of verbal de-escalation by nurses were patients with a history of restraint episodes and patients who previously had been administered medication. Furthermore, episodes of mechanical restraint that occurred later during the admission were also associated with the use of de-escalation. These findings confirm the relevance of early nurse interventions. Consequently, it is important to establish an adequate therapeutic relationship from the start of hospitalization to facilitate getting to know the patient and to enable the timely use of verbal de-escalation, thus avoiding the use of mechanical restraint.

Electroconvulsive therapy protocol adaptation during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, electroconvulsive therapy units have had to confront challenges such as the infectious hazard due to aerosol-generating ventilation, or the lack of staff and material resources. Our objective was to elaborate a protocol to make ECT during the COVID-19 pandemic a safer procedure for patients and professionals. METHODS: A multidisciplinary workgroup (including mental health, anesthesia, preventive medicine, and occupational risk professionals) was formed in the Hospital Clínic de Barcelona, in March 2020. A core group conducted a review of the scientific literature and healthcare organizations' guidelines and wrote a protocol draft. Then, a discussion with the workgroup was made until consensus was reached. The protocol has been continuously updated. Discussions were made by group e-mailing and video conferencing. RESULTS: The protocol includes the following main areas: (1) ECT unit's structural and functional considerations; (2) SARS-CoV-2 screening protocol; (3) ECT clinical practice adaptation (personal protective equipment, airway management, recovery room, and maintenance of the facilities); (4) management of COVID-19 cases; and (5) protocol assessment. LIMITATIONS: The literature review was not systematic; the consensus was not based on a structured methodology. For other ECT units, local advisories may not be valid, and resource shortages (such as anesthetist availability, or the lack of respirators and PCR tests) may impede or prevent their implementation. CONCLUSIONS: During the COVID-19 pandemic, ECT should continue to be advocated as an essential medical procedure. It is recommended that each ECT unit develop its own protocol. This proposal may be used as a reference.

Clinical profile of inpatients referred to a consultation-liaison psychiatry service: an observational study assessing changes over a 10-yearperiod.

OBJECTIVE: Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005–2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years. METHODS: Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service. RESULTS: 9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes. CONCLUSIONS: Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty.

Características clínicas de los pacientes derivados a un servicio hospitalario de psiquiatría de enlace e interconsulta: un estudio observacional evaluando cambios a lo largo de un período de 10 años / Clinical profile of inpatients referred to a consultation-liaison psychiatry service: an observational study assessing changes over a 10-year-period

Objetivo. Existen diversas investigaciones previas que han descrito las características de distintos servicios hospitalarios de Psiquiatría de Enlace e Interconsulta (PEI) a lo largo de un periodo de tiempo de uno o más años. El propósito del presente artículo es el de examinar las características de una muestra amplia de pacientes remitidos a un servicio hospitalario de PEI, durante un período de 10 años (2005-2014) y determinar los posibles cambios de la práctica clínica a lo largo del tiempo. El tamaño muestral de nuestro estudio, la duración del periodo de observación y la aplicación de procedimientos estandarizados para la obtención y codificación de los datos, aportan una evidencia más sólida en comparación con otros estudios similares publicados en los últimos años. Métodos. Estudio observacional, longitudinal y descriptivo. Los datos se recopilaron de forma prospectiva mediante procedimientos estandarizados, en base a las solicitudes recibidas en el servicio hospitalario de PEI del Hospital Clínico Universitario de Barcelona. Resultados. se solicitaron un total de 9.808 consultas psiquiátricas (tasa de derivación=2,2%). Las derivaciones a nuestro servicio fueron realizadas principalmente por unidades médicas. Los diagnósticos psiquiátricos más frecuentes fueron los trastornos relacionados con el consumo de alcohol, los cuadros confusionales y los trastornos de adaptación. El porcentaje medio de pacientes manejados con tratamiento psicofarmacológico fue del 81,6%. La duración media de las hospitalizaciones de los pacientes con comorbilidad psiquiátrica, derivados a nuestro servicio de psiquiatría de enlace, fue significativamente mayor a la estancia media global del hospital durante ese periodo. La mayoría de las variables estudiadas permanecieron constantes durante el período de 10 años. Sin embargo, algunos diagnósticos médicos en el momento del ingreso, motivos de derivación y recomendaciones de tratamiento psicofarmacológico presentaron cambios significativos. Conclusiones. A pesar de la evolución continua y los importantes cambios que se han producido en los sistemas de salud en las dos últimas décadas, la práctica clínica de los servicios de PEI ha permanecido bastante estable en el tiempo. Sin embargo, nuestros resultados apoyan la idea de una especialidad dinámica

Objective. Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005-2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years. Methods. Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service. Results. 9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes. Conclusions. Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty