Using a Decision Wheel to Reduce Use of Restraints in a Medical-Surgical Intensive Care Unit

Little information is available on the use of tools in intensive care units to help nurses determine when to restrain a patient. Patients in medical-surgical intensive care units are often restrained for their safety to prevent them from removing therapeutic devices. Research indicates that restraints do not necessarily prevent injuries or removal of devices by patients.

To decrease use of restraints in a medical-surgical intensive care unit and to determine if a decision support tool is useful in helping bedside nurses determine whether or not to restrain a patient.

A quasi-experimental study design was used for this pilot study. Data were collected for each patient each shift indicating if therapeutic devices were removed and if restraints were used. An online educational activity supplemented by 1-on-1 discussion about proper use of restraints, alternatives, and use of a restraint decision tool was provided. Frequency of restraint use was determined. Descriptive statistics and thematic analysis were used to examine nurses' perceptions of the decision support tool.

Use of restraints was reduced 32%. No unplanned extubations or disruption of life-threatening therapeutic devices by unrestrained patients occurred.

With implementation of the decision support tool, nurses decreased their use of restraints yet maintained patients' safety. A decision support tool may help nurses who are undecided or who need reassurance on their decision to restrain or not restrain a patient.