Safety incidents for patients and staff have been recognised during seclusion and restraint events in psychiatric inpatient care. This study aimed to identify safety incidents and their contributing risk factors in seclusion and restraint events in psychiatric inpatient care. The existing practices, incidents, and contributing risk factors were explored.

The study was conducted in three phases. In the first phase, focus groups were used to identify psychiatric nurses’ experiences of nursing practices, safety incidents, and risk factors in seclusion and restraint events. In the second phase, existing practices, safety incidents and risk factors were explored using video observations of seclusion and restraint events. In the third phase, risk factors for falls in seclusion were modelled based on existing literature and the expertise of psychiatric nurses using sociotechnical probabilistic risk assessment.

Based on the findings of this study, existing practices of seclusion and restraint consist of nursing interventions to meet the needs of patients. The identified safety incidents included assaults, falls, medication errors, elopement, self-harm and others. Safety incidents were found to potentially affect both patients and nurses. The contributing risk factors for safety incidents in seclusion and restraint were unsafe acts of nurses and patients as well as latent conditions in the system. These unsafe acts and latent conditions were visible in the example of falls in seclusion.

Based on the gathered recommendations for improving safety in seclusion and restraint events in psychiatric inpatient care, changes are needed in clinical nursing practice, in nursing education and training, in the support from nursing management, and in the broader organisation. According to the presented recommendations, there is a need to adopt a system-level approach.