What Is Seclusion Nursing?

“It should be used only as last resort after all other intervention has not been successful.”

Plaxedes explains how nursing a patient in seclusion works and gives some tips on how to deal with the process successfully.

Topics Covered In This Article

What Is A Seclusion Room?

How Is Seclusion Nursing Initiated?

What Steps Are Taken To Ensure Patient Safety?

What Is The Protocol Followed In Seclusion Nursing?

What Skills Or Qualifications Are Required To Observe A Patient In Seclusion?

Points To Note

What Is A Seclusion Room?

A seclusion room is a specially designated room which is designed for Nursing patients presenting with extreme violent behaviour.

A seclusion room is commonly used in Mental Health Acute settings, mainly Psychiatric Intensive Care Unit (PICU) to ensure the patient is nursed in a safe and secure environment.

Use of Seclusion is guided by local Trust Policy, Mental Health Legislation and National standards.

How Is Seclusion Nursing Initiated?

Seclusion is used when a patient becomes physically aggressive or threatens violence to others and also placing themselves at risk.

This is treated as an emergency, considering the patient’s own safety and others.

The Patient Safety and Therapeutic Services Team (PSTS) or response are called to help with restraining or escort the patient without restraint if they are co-operative.

Usually a Senior Nurse or Duty Senior Nurse must be present to formally initiate the Seclusion jointly with the Nurse from the admitting ward.

It is important to explain to the patient that they are not being punished by nursing them in seclusion but that it is for their safety and the safety of others.

What Steps Are Taken To Ensure Patient Safety?

Seclusion is strictly guided by local Trust Policy which has to be followed.

Any concerns or disruptions affecting reviews have to be clearly documented.

The Nurse from the Ward makes the initial entry, recording all the circumstances leading to the seclusion.

A full risk assessment is carried out and items which might harm the patient must be removed from the patient. These include any sharp objects, ligatures, torn clothes or pyjamas.

The seclusion room must also be warm with good lighting.

Procedure for seclusion should be explained to the patient.

The patient should be assured that there will be a member of staff available at all times and that they can make reasonable requests like making a phone call, or staff ordering takeaway for them.

A list of requests they can make and a clock is usually placed within visibility.

They can also request staff to play music on the computer which is also used by staff.

The patient‘s physical health is checked immediately and recorded on the chart and any concerns reported.

If the patient had Rapid Tranquilization Protocol followed, the Ward or Duty Doctor is notified immediately.

Food and drinks are provided and the food and fluid chart is put in place.

Only finger food should be offered and taking note of food temperatures.

The Ward Manager of the Admitting Ward, Modern Matron and Clinical Service Managers should also be notified in case the patient ‘s circumstances change, in view of restraint and Rapid Tranquilization.

Datix or Incident Report has to be completed regarding seclusion initiation.

Family and relatives should be notified about seclusion and that they will be updated on patient’s progress and they can make an appointment to visit if the patient consents.

The Modern Matron visit or request Feedback after every Review to ensure patient is safe.

What Is The Protocol Followed In Seclusion Nursing?

There is a strict seclusion policy in place which guides staff, and this is occasionally reviewed if there is a serious or untoward incident related to seclusion.

The patient is supposed to be reviewed by the Doctor withing an hour of initiation followed By a Nursing Review every 2 hours.

However, if there is any deterioration in patient ‘s condition or immediate risk to their safety this can be done immediately, in case the patient might require urgent treatment in A&E or Urgent Care.

Patient’s personal hygiene needs should also be taken care of and the patient is offered toiletries, towels and hospital clothes, or theirs to change.

A Medical Review follows in the 4th hour, until reviewed by a Senior Medical Doctor in 8 hours (these may very depending on the availability of the Senior Medical Doctor at the time).

Another Doctor maybe requested to review the patient.

The Doctor will check on the patient’s general well-being and look at the vital signs.

They will also a physical examination and review medication if needed.

They will then conduct a brief mental health assessment to monitor their mental well-being and signs of improvement, or the patient calming down.

They will also make the patient understands the reason why they were being nursed in seclusion.

A Consultant who is the most senior Medical Clinician will review the patient in 24hours but can also be called if the Senior Medical Doctor is not available or busy elsewhere on other Wards or A&E.

The review process is continually repeated in the same order, until the patient is much calmer and ready for step down to an open room which is less restrictive.

A 24 hour report to the Senior Managers is completed followed by daily subsequent updates and escalation till Seclusion is terminated and the patient’s mental state has improved, and they are beginning to show some insight into their situation.

What Skills Or Qualifications Are Required To Observe A Patient In Seclusion?

A Qualified RMN or Healthcare Assistant who is experienced had training competencies in seclusion observations.

The Ward Consultant is overall in charge of the patient care in Seclusion and in their absence another Consultant will take charge.

Points To Note

It should be used only as last resort after all other intervention has not been successful.

Patient safety is priority and so physical well-being, food and fluid should be strictly monitored and any deterioration reported.