3553 Transitioning from Prevalence to Incidence Restraint Reporting: A Dramatic Reduction in Restraint Usage

Friday, January 22, 2010: 11:05 AM
Judith A. Church, DHA, MSN, ACNPC, NEA-BC, ACNP-BC , Nursing, Kettering Medical Center, Kettering, OH
Dianne Ditmer, Ph.D., MS, RN, CFN, DABFN, FACFE, CRM, CMI, S.A.N.E , Nursing, Kettering Medical Center, Kettering, OH
Roxanne Ehrhart, BSN, ACM, MCSM , Nursing, Kettering Medical Center, Kettering, OH
Purpose:
The issue was use of prevalence versus incidence restraint use data to develop patient care plans, involving non-behavioral, non-violent restraint application. The goal was to provide current data for staff to incorporate into patient care plans and induce staff ownership of unit restraint data.

Significance:
Non-behavioral, non-violent restraint application is a national patient safety issue, a Joint Commission standard, and may challenge ethical principles of autonomy, benficence, and justice. To optimize restraint use reduction, nurses should be afforded current data to develop patient care plans.

Strategy and Implementation:
As presented in our Magnet redesignation evidence, only 8 of 19 nursing units met or exceeded prevalence restraint NDNQI benchmark at least 50% of the time across 8 quarters of data reporting. On March 1st restraint data incidence reporting by unit CNM or designee to a MIDAS database was launched. By 1000 each day, a unit's non-behavioral, non-violent restraint use is electronically reported. A daily composite is reported in the afternoon to all nursing units; each unit's restraint use is transparent to all other units. Additionally, the night supervisor displays each unit's restraint use as of the midnight census report, which is emailed to all nursing units, managers, and directors each morning by 0700. Implementing incidence restraint reporting versus prevalence NDNQI data results instilled in nurses a sense of data ownership, provided "realtime" data from which to develop patient care plans,compeled staff participation in data transparency, and resulted in restraint use reduction.

Evaluation:
Initial incidence data March-April 2009: 12/22 (55%) reporting units exceeded (better than) internal benchmark of 3%;10/22 (45%) were higher than 3% internal benchmark. July 15, 2009: 14/18 (78%)report 0% restraint use, 4 units each with 1 patient in restraints, 2 units exceed internal 3% benchmark.

Implications for Practice:
Incidence restraint data reporting with subsequent reduction in restraint use provides practice implications for: institution (reduction in risk management issues),nurses(develop patient care plans based on current data),patient(care sensitive to autonomy, beneficence, justice, safety, quality).

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