Use of a computerized forcing function improves performance in ordering restraints.

Area of Science:

• Medical Informatics
• Patient Safety
• Healthcare Systems Engineering

Background:

• Physical restraints are used in healthcare settings, but their prolonged use can lead to adverse events.
• Timely renewal of restraint orders is crucial for patient safety and adherence to best practices.
• Computerized order entry systems offer potential for improving clinical workflows and patient care.

Purpose of the Study:

• To evaluate the impact of a computerized order entry system's forcing function on the timely renewal of physical restraint orders.
• To assess changes in restraint order frequency, renewal rates, and duration of restraint use.

Main Methods:

• A prospective study with two successive interventions using a computerized order entry system.
• Physicians received computerized reminders for restraint order renewal, with a 'forcing function' implemented later that denied computer access until orders were addressed.
• Chart review analyzed restraint order renewal times, order counts, renewal rates per hour, and time in restraints across three 6-month periods.

Main Results:

• Median time to restraint order renewal significantly decreased by 56-64 minutes.
• The mean number of restraint orders and renewal orders per hour significantly increased.
• Variability in order renewal times decreased, while variability in order counts and renewal rates increased.
• Median time spent in restraints decreased, though not to a statistically significant level.

Conclusions:

• The computerized forcing function effectively improved restraint order renewal timeliness and reduced practice variability.
• The intervention may have contributed to observed reductions in patient time spent in restraints.
• This highlights the potential of health information technology to enhance patient safety protocols.