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Published on: September 30, 2020
Decline in Physical Restraint Use Following Implementation of Institutional Guidelines
Lisa B E Shields1, Avalena Edelen, Michael W Daniels
1Author Affiliations: Medical Research Associate, Norton Neuroscience Institute (Dr Shields), and Manager of Quality and Regulation, Quality Research Management (Ms Edelen), Norton Healthcare; Biostatistician (Mr Daniels), Department of Bioinformatics & Biostatistics, University of Louisville; Vice President of Patient Care Services and Chief Nursing Officer (Dr Flanders), Practice Administration, Norton Healthcare, Louisville, Kentucky.
Objective:
To investigate the strategies implemented at our institution to reduce medical restraint use.
Background:
Restraints have been utilized to prevent agitation, self-extubations, and falls, although they are often associated with negative repercussions for nurses and patients.
Methods:
The restraint data at our institution were compared with the National Database of Nursing Quality Indicators (NDNQI) benchmark. We also described the measures taken to improve restraint documentation.
Results:
The number of patients in medical restraints, medical restraint hours, medical restraints/patient-days, and deaths in restraints at our institution all significantly decreased (P < 0.00001). There were 27 self-extubations of restrained patients compared with 11 self-extubations of nonrestrained patients. The percentage of inpatients with restraints in critical care and step-down areas declined and remained below the NDNQI benchmark.
Conclusions:
This study reports the processes implemented to reduce restraint use through enhanced communication and increased documentation. Further exploration into factors that may attain a restraint-free environment is warranted.
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