Twilight (The Flamingo Hotel)
Monday, 29 January 2007
6:30 PM - 8:00 PM
Twilight (The Flamingo Hotel)
Tuesday, 30 January 2007
4:30 PM - 6:00 PM

Rehabilitation Patient Satisfaction and Safety through Restraint Reduction

Karen Hodroff, BS, RN, C, CNN, Inpatient Rehabilitation, Advocate Lutheran General Hospital, 1775 W. Dempster, Park Ridge, IL 60068

The educational objectives in this program are to teach nursing leaders how my team learned to effectively change a practice culture for greater patient safety and satisfaction; how to more appropriately assess patients for restraint use and how to utilize restraint alternatives increasing quality patient care.  I want to share our successful restraint reduction initiatives with others involved in caring for this complex and challenging patient population.  The implications for nursing practice and leaders in implementing restraint alternatives has had such a significant impact on our patient outcomes, my desire is to help other nursing leaders learn how they can have equally dramatic changes and positive outcomes in their practices.

 

Rehabilitation Nursing poses unique challenges in caring for patients with physical, mental, and cognitive disabilities.  Frequently, patients requiring inpatient rehabilitation have had strokes, traumatic brain injuries, spinal cord injuries, or have complex medical diagnoses resulting in debility necessitating intensive therapies in order to return to a quality of life similar to what the patient had before admission.

 

The thirty seven bed inpatient rehabilitation unit at ALGH, which I manage, has many stroke and brain injury patients whose behavioral issues have been managed through the use of restraints.  The physician group’s culture dictates that the patient is safest when restrained through the use of four side rails while in bed, lap belts and Posey vests when in their wheelchair.  The fear is, especially with brain injured patients, that if not restrained, there may be a catastrophic event should the patient wander off, or fall.

 

In March and April, the nursing staff spent time reviewing the NDNQI safety data about restraint usage on the unit and found that 100% of the patients were using some type of restraint.  Our Nursing Action Forum leaders met to discuss how to change these results and minimize the use of restraints.  We knew we needed to educate ourselves and the physicians on restraint alternatives in order to change the culture in which we worked.

 

We began with researching the literature for alternatives, educating ourselves about these alternatives and then empowering the nurses to begin the physician education process which would allow us to change our practice.  The results were significant.  In April, 100% of our patients were restrained; by May 66% were restrained, and by September only 14% of the population was restrained.

 

Research, education, and staff empowerment have made our restraint reduction program extremely successful.  The results are dramatic.  We not only have safer, more satisfied patients and staff, but have not increased our falls, and have dramatically decreased nosocomial skin breakdown in the process.

 


See more of Evidence Based Practices
See more of The NDNQI Data Use Conference (January 29-31, 2007)