Knot-So-Fast: a learning plan to minimize patient restraint in critical care

In 2001, new legislation in Ontario, the Patient Restraint Minimization Act, mandated that all hospitals develop a policy to minimize the use of restraints. Since restraining patients was a common practice in our intensive care unit (ICU), a practice change was necessary. To do this, a learning plan was created to share key information pertaining to the Act that would support humane and dignified care for our critically ill patients. Change was accomplished through a survey of nursing staff to establish learning needs, the development of a learning plan titled "Knot-So-Fast", and the creation of a tool titled the "Restraint Decision Wheel" to support staff in making restraint decisions quickly and appropriately. To measure the effect of our Knot-So-Fast learning plan, the staff was resurveyed one year later. Results showed there was a statistically significant decrease in restraint use in our ICU. The learning plan and tools developed have been found to be adaptable to other hospital units and are provided. This article includes the educational content and methods used in our ICU to effect a change in restraint practice. Tools, such as a nursing survey and a decision wheel, developed to enhance learning are also included.