The Douglas protocol on the Use of Control Measures has been recently updated, based on the Institute’s changing needs. It affirms that Douglas staff should use control measures only if there is real danger to a patient or to others, and if alternate measures have failed.

This protocol advocates a progressive philosophy, aimed at controlling inappropriate patient behaviour. The protocol was penned in large part by Hélène Laberge, chair of the Douglas Control Measures Committee. The committee was created to ensure that the rules governing Douglas control measures (seclusion rooms, mechanical restraints, or chemical restraints) are clear, respectful of patients, and in line with the latest Ministry of Health and Social Services guidelines and Mental Health Action Plan objectives.

A Plus for Patients

The protocol stipulates that the use of any control measures must be recorded in a patient’s file. Each use must also be recorded in Douglas indicators—statistical information that is sent to the Ministry. As well, any controlled measures use is reviewed by the staff team, who work together to find ways to avoid its use in the future. The patient’s input is a vital part of this review process.

Denise Couture, a social worker in Emergency and Intensive Care, has noted fewer complaints from patients and their families regarding the use of controlled measures, “In Intensive Care, patients and their families are now provided with more information when controlled measures are used. They’re also encouraged to suggest ways to avoid control measure use in the future. This ensures families stay informed and are part of the solution.”

Adds Intellectual Handicap with Psychiatric Comorbidity Program Chief Debbie Nasheim, “Throughout the Douglas, we’re constantly working to decrease the use of control measures. On Burgess 2, for example, its use was down 12 percent last year, and 30 percent the year before.”

“The key,” explains Hélène Laberge, “is to have a strong relationship between patients and staff. When patients feel agitated, our staff helps them to react constructively by providing therapy based on their individual preferences. For some patients, soft lighting helps. For others, it may be classical music. Every patient is unique.”

A Plus for Staff

Some patients may resent a person who applies a control measure. Therefore a reduction in the use of control measures can improve the relationship between patients and clinical staff. As well, when fewer controls measures are used, fewer reports need to be written! Teams find it more satisfying to develop alternative solutions, since these solutions are better received by patients, and call upon the team’s creativity. Denise Couture adds, “One way teams are doing this is by recording successful strategies for avoiding control measures. With these improvements, staff are forming strong therapeutic links with their patients and ensuring they are treated in the most positive, respectful way possible.”