Risk Factors for Mechanical Restraint Use in Non-ICU Hospitalized Patients With Delirium

We investigated demographic and clinical factors that contribute to a patient receiving mechanical restraints while hospitalized, with particular focus on the results of delirium screening and receipt of antipsychotics as risk factors.

We conducted a retrospective cohort study of all non-ICU adult patients admitted to a large academic hospital between August 1, 2018, and January 31, 2021. Sociodemographic data, the results of the brief confusion assessment method (bCAM) screening, and receipt of antipsychotic medication were collected and analyzed. Univariate and multivariable logistic regression analyses were used to determine the impact of receipt of an order for mechanical restraints on the primary outcome.

The study included 23,366 non-ICU admissions, of which 408 received mechanical restraints during their hospitalization. There were 1379 (5.90%) admissions with a positive delirium screen, and 4939 (21.5%) of patients received an antipsychotic. When adjusting for sociodemographic factors, receiving an antipsychotic had an OR of 9.1 (95% CI: 6.41-12.93) for having an order for mechanical restraints. A positive bCAM had an OR of 27.94 (95% CI: 18.65-41.86), and a positive bCAM and receipt of an antipsychotic had an OR of 190.30 (95% CI: 135.34-267.58) of having an order for mechanical restraints.

Our findings support the understanding that delirium and antipsychotics are enormous risk factors for a patient receiving mechanical restraints. And while many patients receive antipsychotics first, some do not, representing an important area for improvement in patient safety.