The Restraint Team: Using Relational Coordination to Create Meaning

Purpose:
Increase capacity to keep patients safe while reducing restraint utilization through integrating relational coordination.

Significance:
Seventy-four percent of nurses employ restraints as their first choice to keep patients safe, while 45 percent suggested they would try alternatives. Shared knowledge, goals and respect among providers dramatically impacts nurse-sensitive outcomes including restraint utilization reduction.

Strategy and Implementation:
Rules and regulations rarely energize improvement teams or direct caregivers. We sought another method to create meaning around restraint work and chose to apply relational coordination; the coordination of work through relationships of shared goals, shared knowledge and mutual respect (Gittell, 2009). Work began by reforming the restraint team. Membership was intentional, by invitation and included physician participation. Individuals were chosen based on teamwork skills, specific knowledge base and ability to be boundary spanners – either by role or aptitude. Restraint education is in development around the shared goals of preserving patient dignity and safely reducing restraint prevalence. Information technology is being leveraged to prompt continual assessment of restraint need (supporting discontinuation at the earliest possible time), making adherence seamless and easily measuring compliance through automated auditing.

Evaluation:
Evaluation includes restraint utilization compared to NDNQI colleagues, RN engagement regarding evidence-based methods of keeping patients safe while minimizing restraint utilization and demonstrated interdisciplinary safety organizing.

Implications for Practice:
Restraints are a microcosm of our complex healthcare system. They are highly regulated, require collaboration across roles, impact patient safety and impinge on patient rights. Applying relational coordination to restraint work moves hospitals towards safe, reliable and minimal restraint use.