ICU Restraint Reduction: Development of Evidence Based Tools to Guide Interventions

Purpose:
Hospitals continue to struggle to develop effective strategies to reduce restraint use in the ICU. Restraint use in many ICUs was above the NDNQI benchmark. Our goal was to reduce restraints using innovative, evidence based interventions to move at or below the NDNQI benchmark.

Significance:
ICU patients are frequently intubated and prone to develop pain, anxiety and delirium. Early extubation, assessing and treating the underlying causes, is imperative. Managing and monitoring patients at risk using innovative tools while maintaining patient safety can reduce the need for restraints.

Strategy and Implementation:
The Fastrac methodology was used to improve our NDNQI data. The Fastrac work group included leadership, staff nurses, and nurse educators. Three tools were developed to include a restraint minimization algorithm, a ventilator liberation algorithm and a family brochure. Algorithms' focused on assessment of underlying causes and the brochure encouraged family involvement at the bedside. The final products were presented to all ICU leadership and key stakeholders. To promote the use of the tools, a poster of the interventions was developed and displayed at competency days for viewing. Posters were then distributed to each ICU and education was provided to the nursing staff by Clinical Instructors. The brochure was made available to all families of ICU patients. The ventilator liberation algorithm was also distributed to ICU Respiratory Therapists and Medical Directors. Daily restraint rounding by Clinical Nurse Specialists sustains the use of the tools and decrease the use of restraints.

Evaluation:
Reducing restraint use was achieved through educating frontline staff and family involvement. Sustaining results continues through monthly prevalence observations using the NDNQI criterion. Using data to drive improvements in the quality of care by minimizing the use of restraints is necessary.

Implications for Practice:
ICU nurses must keep vital therapies intact while maintaining human dignity. Assessing the need for restraints, these tools enhance nurse's decision making process by placing the focus on underlying causes for patient behaviors. Appropriate interventions are then chosen to improve patient outcomes.