The Effect of a Care Bundle on Physical Restraint Rate, Duration and Complications in ICU Patients

Area of Science:

• Critical Care Medicine
• Patient Safety
• Nursing Interventions

Background:

• Physical restraint is a common practice in intensive care units (ICUs), often associated with adverse events.
• Reducing the rate, duration, and complications of physical restraint is crucial for improving patient outcomes and safety.

Purpose of the Study:

• To evaluate the effectiveness of the Physical Restraint Reduction Care Bundle (PRRCB) in reducing the rate, duration, and complications of physical restraint use.
• To assess the impact of an i-PARIHS framework-guided intervention on physical restraint practices in a Turkish university hospital ICU.

Main Methods:

• A quasi-experimental pre-post observational study design was employed.
• The i-PARIHS framework guided the development and implementation of the PRRCB, which included guidelines, care maps, training, and decision support tools.
• Literature review and modified Delphi methods were used to develop evidence-based guidelines.

Main Results:

• A statistically significant reduction in the rate of physical restraint was observed post-intervention (48.1% to 39.7%).
• The odds of physical restraint were significantly lower after the intervention (OR=0.71).
• A significant decrease in all assessed complications, including extremity color, temperature, edema, pitting, and skin integrity, was noted.

Conclusions:

• The i-PARIHS-guided PRRCB effectively reduced the rate and complications associated with physical restraint in the ICU.
• While the intervention improved restraint-related complications, it did not significantly decrease the mean duration of physical restraint.