Sustained Reduction of Restraint Usage in a Veterans' hospital: A successful philosophical change

Purpose:
In FY 2007,Veterans Health Care System of the Ozarks (VHSO) committed to reduce restraint usage. VHSO began gathering research evidence regarding the use of physical restraints.VHSO determined restraint use could be decreased without increased fall rates or risk to patients.

Significance:
Restraint use in acute care settings creates stress for the patient,family members, and caregivers. Restraint use also conflicts with Veteran-centered care and mission that works to honor America's Veterans by providing exceptional health care that improves their health and well-being.

Strategy and Implementation:
Discussion ensued regarding the best measurement process to indicate significant improvement. The National Veterans' Affairs database measured restraint usage in rate per 1000/BDOC. This particular rate did not ensure the sensitivity that VHSO deemed useful in measuring success. Next, staff attitudes regarding restraints required focused education as well as a comprehensive plan providing alternatives to restraint use. This three pronged approach included policy change with education, measurement, and alternative options. Extensive education was accomplished with the medical staff and the front line staff regarding the proposed changes. Evidence was provided to all the staff and restraint usage was further integrated into staff competency assessments. Educational goals included affecting culture change toward restraint usage moving away from a philosophy that found restraint usage acceptable to viewing restraint usage as treatment failure or failure to meet the patient's needs.

Evaluation:
VHSO opted to evaluate local hours per month and joined NDNQI(2009)to enhance comparisons.VHSO assesses and reports alternative interventions.From FY 09 – FY 10 VHSO experienced the following: 44% overall decrease of restraint usage and 50% decrease for ventilator patients restraint usage

Implications for Practice:
Interdisciplinary nurse involvement and comprehensive education program affects bedside practice and cultural views on restraint usage. A change in philosophy results in significant decrease of restraint usage and enhances the VA mission.