Development and testing of tools to assess physical restraint use

Area of Science:

• Healthcare quality improvement
• Patient safety research
• Clinical assessment tools

Background:

• Healthcare providers need accurate data on physical restraint use to implement best practices.
• Existing methods for assessing restraint use may not be feasible or rapid in clinical settings.
• A reliable and valid instrument is needed to quickly evaluate physical restraint application.

Purpose of the Study:

• To develop and test two instruments for assessing physical restraint use: an observation tool and a chart audit.
• To evaluate the feasibility, reliability, and comparability of these tools in complex continuing care and rehabilitation units.
• To inform best practices in restraint management within healthcare organizations.

Main Methods:

• Developed and piloted an observation tool and a chart audit instrument.
• Administered the observation tool via trained observers over two weeks in two healthcare organizations.
• Conducted chart audits for a sample of residents and assessed inter-rater agreement and prevalence estimates.

Main Results:

• Observation and chart audit tools were feasible for assessing physical restraint use, with varying prevalence between sites.
• Excellent inter-rater agreement was found for most observation tool items, with noted exceptions.
• Significant concordance was observed between the observation tool and chart audit, though not complete agreement.

Conclusions:

• The developed observation and chart audit tools are feasible and reliable for assessing physical restraint use.
• Recommendations include adding items on patient mobility, waking status, and restraint restriction to the observation tool.
• These complementary tools should be used together to comprehensively understand restraint use in healthcare settings.