A Fresh Look at Restraint Use in the ICU

Purpose:
The purpose of this project was to assess the current state of restraint use in the ICUs, compare to a national benchmark and to reduce the use of restraints when possible.

Significance:
The use of restraints has complex legal, safety, and pyschological implications. We must ensure an environment where restraint use is minimized or eliminated. Due to the risks involved, the use of restraints is also highly regulated.

Strategy and Implementation:
A restraint task force was established. This team quickly identified that the information that was being shared had little perceived value. Change began by first identifying patients in real time who are restrained. We used this information to estimate a daily restraint prevalence on each unit. Run charts were created for easy viewing. This information was then shared on a regular basis with leadership. It was also communicated to bedside staff both directly and through trickle down from management. The team identified our own barriers to reduction of restraints and then conducted a literature review. Restraint champions who served on the task force shared the evidence with nursing units at the saff level. We specifically challenged the persistent culture of "The intubated patient must be restrained." Finally, we began using control charts in order to help identify and subsequently address special cause variations.

Evaluation:
We have been successful in reducing our ICU restraint prevalence mean from over 24% down to 14.6%. We have shown no increase in unplanned extubations with reintubation.

Implications for Practice:
A change in practice requires almost constant nuturing and support until it becomes a change in culture. Keys to our success include sharing real time data on a regular basis, debunking myths with evidence, and having champions who are at the unit level.