Prevalence of chemical restraint use in hospital care: a consensus and cross-sectional study

Restrictive practices are interventions that limit the rights or freedom of movement of a care recipient. Using medicines to manage behaviours that pose a threat to the patient or others is referred to as chemical restraint. Guidance in Australia for monitoring chemical restraint has largely focused on the aged care and disability sectors. In contrast, far less is known about chemical restraint use in the hospital inpatient setting. This study aims to reach a health service-wide consensus on a chemical restraint definition and a list of medicines used for inpatient care. It also aims to determine the prevalence of chemical restraint use across a large health network.

A modified-Delphi consensus and cross-sectional period prevalence study was undertaken across a large health service in Australia. A multidisciplinary clinical reference group participated in three survey rounds to determine a definition and list of medicines. Period prevalence (%) was determined using inpatient medical notes, and differences between clinical speciality prescriptions and administration were determined by odds ratio (P < .05).

The Australian Commission on Safety and Quality in Healthcare definition was adopted, and any prescription of an antipsychotic, sedative/hypnotic, ketamine, or propofol was assessed. There were 16.73% (95% CI 14.4% to 19.1%) of patients prescribed and 10.03% (95% CI 7.97% to 12.09%) administered a medicine for chemical restraint. Chemical restraint was prevalent across a range of clinical specialties, with mental health patients 17 times more likely to be exposed ([OR] 17.18, 95% CI 8.74-33.77, P < .001). Olanzapine was the most commonly prescribed medicine (69, 29.11%) with 79.75% (189) of all medicines prescribed pro re nata. Consent was documented for four (5.63%) patients.

Chemical restraint is prescribed across a range of hospital clinical specialties with low rates of documented consent. Adopting a standardized approach could improve existing hospital safety and quality policy and practices.