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Prevalence of use of physical restraints in pediatric intensive care units and correlated variables: A Spanish
Alejandro Bosch Alcaraz1, Sylvia Belda Hofheinz2, Jesús Corrionero Alegre3
1Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona (UB), Barcelona, Spain; Mental Health, Psychosocial and Complex Nursing Care Research Group-NURSEARCH, University of Barcelona, Barcelona, Spain.
Insights
Physical restraint (PR) use remains prevalent in Spanish pediatric intensive care units (PICUs) at 16%. Respiratory conditions and initial admission status significantly influence the duration of PR use in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Patient safety research
Background:
- Physical restraint (PR) is a practice used in pediatric intensive care units (PICUs).
- Understanding the prevalence and influencing factors of PR use is crucial for improving patient care and safety.
Purpose of the Study:
- To determine the prevalence of physical restraint (PR) use in Spanish PICUs.
- To analyze the association between PR use and patient/PICU characteristics.
Main Methods:
- A multicenter prevalence study was conducted in Spanish PICUs from January 2022 to January 2023.
- Data were collected through direct observation, medical record review, and professional interviews.
- Six months of data collection involved three weekly 24-hour observations.
Main Results:
- The overall crude prevalence of PR use was 16% (95% CI: 15%-17.7%) among 336 patients.
- Pediatric patients with respiratory conditions received PR for longer durations compared to post-surgical patients.
- Admission diagnosis, particularly respiratory issues, significantly impacted PR duration.
Conclusions:
- Physical restraint (PR) use is still a reality in Spanish PICUs, with a 16% prevalence.
- Factors like admission diagnosis, respiratory support, and the reason for restraint application correlate with its duration.
- Awareness of PR prevalence necessitates policies to minimize its use and prevent adverse effects in pediatric patients.
Objective:
To calculate the prevalence of physical restraint (PR) use in Spanish PICUs and (2) to analyze the correlation between the prevalence of PR use and the sociodemographic, clinical variables of the patients and the PICU structural and organizational variables.
Methods:
We conducted a multicenter prevalence study from January 2022 to January 2023 in Spanish PICUs. The method of data collection was by direct observation, review of the patient's medical history, and asking the professionals involved in the patient's care. Three weekly 24-hour prevalence observations (morning, afternoon, and night) were conducted for 6 months.
Results:
A total of 336 patients were included in the study, obtaining an overall crude prevalence of PR use of 16 % (95 %CI: 15 %-17.7 %). Pediatric patients with respiratory pathology received the highest number of hours of PR, with significant differences observed when comparing respiratory cases with post-surgical cases. Statistical significance was also observed when comparing the mean scores of hours of PR according to admission diagnosis (p = 0.01), with respiratory patients being the ones who were restrained the longest (24 h [20-24]) and infectious patients the least (15 h [14-20]). Patients who receive PR upon admission remain in this situation for more hours (24 h [15-24] and in the PICUs that specifically recorded PR application, fewer hours of PR occurred (20 h [4-24]).
Conclusions:
The use of PR is still present in the PICUs analyzed, with a crude prevalence of 16%. Factors such as the reason for admission, the use of respiratory support, and the reason for application of PR were linked to the hours of use of PR.
Implications For Clinical Practice:
Knowing the prevalence of PR use will make professionals aware that it is still necessary to implement policies that avoid its use to prevent the side effects they have in pediatric patients.
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