Innovative Strategies to Decrease the Use of Restraints through Education, Teamwork, and Data

Purpose:
Hospitals continue to struggle to develop effective strategies to reduce the use of restraints. Restraint management is shifting towards intervention alternatives to prevent the use of restraints and improve patient outcomes. Our goal was to reduce restraint use through innovative strategies.

Significance:
Restraint use in many units was running at or above the NDNQI benchmark compared to hospitals with 500 beds or greater. It is imperative nurses ensure patient safety and dignity as well as the basic right to be free from restraint. Eliminating any unnecessary use of restraints was a priority.

Strategy and Implementation:
A multidisciplinary Restraint Committee was formed. In an effort to better align restraint management to regulatory standards and decrease the use of restraints the Restraint Committee implemented several initiatives to educate nurses, physicians and other healthcare providers on the use of restraints. The initiatives include: Revision of restraint policies to comply with new regulatory standards and make them more understandable; Restructured nursing restraint documentation in the electronic medical record; Developed a house wide collaborative online education program called “Do the Right Thing”; Revised annual nursing competencies with observation of proper restraint usage and education on alternatives to restraints; Revised the order form to include alternatives and only necessary elements; Revised restraint auditing form and process for ordering; Continued reviews and analysis of restraint data of weekly review of restraint documentation and monthly restraint prevalence data.

Evaluation:
Reduction of restraint use has been achieved through monthly prevalence observations using the NDNQI criterion. Nursing decreased restraint use by 64%. Sustaining results continues through oversight by nursing leadership, education of the frontline staff and timely reporting of prevalence data.

Implications for Practice:
Education related to strategies to reduce restraint use influences nurse's interventions when assessing patients' need for restraints. Using data to drive improvements in quality of care by minimizing the use of restraints through monthly prevalence and weekly compliance reporting is necessary.