Improving Restraint Safety through Improved Electronic Medical Record (EMR) Documentation

Purpose:
To improve restraint safety by improving the accuracy of EPIC EMR documentation. An electronic flowsheet including required regulatory components of restraint documentation was created and implemented. Nurses were prompted to complete the restraint flowsheet and plan of care (POC).

Significance:
Improper use of restraints may result in serious patient harm. Documentation did not always reflect practice resulting in a lack of information to evaluate if the standard of care was met. Adding a concurrent method to identify failure would allow rapid correction of deficiencies.

Strategy and Implementation:
Multiple strategies were used to improve restraint safety: 1) The restraint flowsheet was developed with nursing staff and management 2) Mandatory online training was completed by clinical staff 3) Thirty minutes prior to the AM shift change, when both AM and PM charge nurses were present, an audit of active restraint orders was performed. Any identified deficiencies were then called to the charge nurse(s). Two hours later a second audit verified the deficiencies had been corrected. If not corrected, senior management was notified. 4) Run charts were distributed weekly to management 5) EMR-based metrics of restraint were created to efficiently capture percent of compliance. These metrics were included in the dashboard of nursing-sensitive measures 6) The restraint “problem” was consolidated into a single template in the POC to eliminate duplication and simplify nursing work flow 7) The next step is to establish a sustainable intervention that places the mitigation at the point of care.

Evaluation:
Implementation of the restraint flowsheet and activation of the above process led to improved compliance from 58% to 90% within 4 months. Currently this level of performance has been sustained for an additional 4 months.

Implications for Practice:
Using the flowsheet as a checklist of safety measures to be performed while patients are in restraints is effective in reducing the risk of harm from restraints. Consolidating the POC into one template streamlined RN workflow. Automated metrics leverage the EMR to optimize care & improve outcomes.