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159 Strategies to De-escalate (Ethical Imperative (Treat pt with dignity,…
159 Strategies to De-escalate
Staff Training Interventions
SOE insufficient
Risk Assessment Interventions
Low SOE
Decreasing subsequent aggression
Reducing Seclusion/Restraint
SOE low when applied in a unit wide preventive manner??
Multimodal Interventions
SOE Insufficient
Environmental Interventions
Including Group Psychotherapeutic options
SOE Insufficient
SOE insufficient
Medications Protocols versus other medication protocols
Or alternative strategies
SOE insufficient??
Key Questions
Benefits
Evidence limited
No data supporting Standards of Evidence
Limited confidence in effect
Harms
Evidenced limited
No data supporting Standards of Evidence
Limited confidence in effect
Potential modifying characteristics
Evidence completely absent
No data supporting Standards of Evidence
Limited confidence in effect
Most studies pre/post studies
High Risk of Bias
Therefore cannot draw conclusions related to causality
11 trials eligible for SOE
10 had high/medium risk of bias
Ethical Imperative
Treat pt with dignity
Clinical Mandate to find evidence based solutions
Legal liability associated with failure
More evidence to guide decision making is critical and needed