Restraint practices in Australasian emergency departments

Area of Science:

• Emergency Medicine
• Clinical Practice
• Healthcare Policy

Background:

• Patient restraint is a frequently utilized intervention in emergency departments globally.
• Understanding the nuances of restraint techniques, policies, and training is crucial for patient safety and quality of care.

Purpose of the Study:

• To estimate the utilization rates of various patient restraint techniques.
• To evaluate the existing restraint policies and training programs within Australasian emergency departments.

Main Methods:

• A survey was administered to 116 emergency departments across Australasia.
• Data collected included types of restraint, indications, contraindications, training, policies, documentation, and audit requirements.

Main Results:

• The estimated rate of patient restraint is 3.3 episodes per 1000 presentations, with common indications including violence, psychosis, and acute brain syndrome.
• Chemical restraint is universally used, often with haloperidol, midazolam, or diazepam. Manual restraint precedes chemical or mechanical restraint in many cases.
• Formal training for restraint is infrequent (33% for chemical restraint), and less than half of departments have written policies, with only 11% auditing practices.

Conclusions:

• Patient restraint is a prevalent practice in Australasian emergency departments.
• There is a significant deficit in formal training, documentation, and auditing of restraint practices.
• Addressing these gaps is essential due to the clinical, occupational health, and medico-legal implications of restraint use.