A Collaborative Approach to Minimizing Restraint Use

Purpose:
Goals were to minimize restraints and when restraint was not avoidable, to comply with regulatory requirements for documentation. Compared to NDNQI benchmarks we found opportunities for improvement and during continual readiness preparation there was lack of documentation support use of restraints.

Significance:
Restraint is an affront to the rights and dignity of the patient and can be distressing to the family. It is not congruent with our vision of spiritually centered, holistic care. Consistent efforts toward minimizing restraint use will help us achieve our goal of a restraint free environment.

Strategy and Implementation:
A team of nurses was convened to identify strategies to reduce restraint use and improve documentation. No major changes were made to policy or practice, the focus of interventions included promoting compliance. Managers and leaders were engaged so they could assist with coaching and feedback. The plan began with an educational focus targeting multiple groups including managers, preceptors, Shared Governance members, staff nurses, and unit based champions. A daily census of patients in restraint was distributed to managers and an advance practice nurse with expertise in restraint. For three months the advance practice nurse rounded with managers and staff. Just in time coaching was provided at the bedside; safety huddles and hand off tools were refined. Lessons learned were published in “Restraint FAQs” and the nursing newsletter. Management and Nurse Practice Council agendas included NDNQI reports on restraint utilization and documentation audits to track progress.

Evaluation:
There is heightened awareness of restraint use. Success is measured through incidence and quarterly prevalence monitoring. Initially, 7 units did not meet the 25th percentile ranking, now all nursing units outside critical care meet. Our next goal is for all units to reach the 10th percentile.

Implications for Practice:
Nurses go through the process of critical thinking prior to application of restraint; they are more creative and vigilant in monitoring patients for safety. Practice is standardized across nursing units, and the culture is shifting. The environment for healing in enhanced.