[Predictors of Adverse Events Following Physical Restraint in Internal Medicine Ward Patients: An Exploratory Study]

Physical restraint, commonly used in medical wards to prevent self-extubation and agitation, sometimes fails to achieve one or both of these objectives. Thus, the factors contributing to the occurrence of self-extubation and agitation under restraint require further exploration.

This study was developed to identify the predictors of two types of adverse events (unplanned device removal and agitation) among hospitalized patients under physical restraint in medical wards.

This retrospective study analyzed the medical records of 100 patients aged ≥ 20 years who had been physically restrained in a regional teaching hospital in Taipei between January 2022 and February 2023. Poisson regression was used to examine predictors across the four domains of demographic, emotional, social, and medical factors.

The significant predictors of extubation during physical restraint identified in the analysis included having a foreign caregiver (B = 0.81, p = .01), emotional instability (B = 1.36, p = .02), a history of extubations during restraint (B = 0.61, p = .02), and a history of agitation episodes before restraint (B = 1.13, p = .04). Predictors of agitation during restraint included use of non-steroidal anti-inflammatory drugs (B = 1.27, p < .01), medication use during agitation (B = 0.75, p < .01), restraint for treatment purposes (B = 0.63, p = .04), and a history of extubations (B = 0.55, p = .02) or agitation (B = 1.44, p = .02).

Based on these findings, recommendations for reducing adverse events following physical restraint include prioritizing family caregivers, receiving routine emotional assessments, monitoring medications, and enhancing communication and non-pharmacological strategies prior to restraint.