Breaking Free From Knots: An Evidence-Based Approach To Physical Restraint Reduction

Purpose:
The purpose of this project is to determine if reduction in restraint usage is achievable in adult patients admitted to a public hospital progressive care unit with a variety of diagnoses including traumatic brain injury and alcohol withdrawal. The goal was to safely minimize restraint prevalence.

Significance:
Restraints in the acute care setting continues to be controversial. Restraints have been linked to unintended outcomes such as death, pressure ulcers, deconditioning and delirium. Several research studies address restraint reduction in acute care settings, but few focus on progressive care units.

Strategy and Implementation:
A modified published restraint survey was given to RNs and unlicensed assistive personnel to assess baseline knowledge, attitudes, and prior experience related to restraints. Restraint prevalence on our progressive care unit has varied between 3.57% and 25.0% from Quarter 1 2008 through Quarter 4 2010 with an average of 11.82%. Literature suggests that an educational in-service can be instrumental in reducing restraint usage. An evidence-based practice in-service was given to nursing and unlicensed assistive personnel about appropriate indications, safe implementation and monitoring, and alternatives to physical restraints.

Evaluation:
As evidenced by our NDNQI restraint prevalence survey there was a reduction in restraint usage from 11.5% to 8.5%. The introduction of the diversionary activity box has been acceptable to both nurses and patients. In addition, evaluations from the restraint inservice were positive.

Implications for Practice:
A restraint inservice has been provided to all medical surgical nursing staff. Decreasing the number of patients restrained and the time spent in restraints assisted with improving the distribution of hospital resources and improved the safety and quality of care that patients receive.