10645
A Nursing Collaborative: Dispeling Sacred Cows and Reducing Restraint Use

Wednesday, February 5, 2014
North Hall Exhibit Hall 6 (Phoenix Convention Center)
Maureen a Seckel, MSN, BSN, RN, APN, ACNS-BC, CCNS, CCRN , Christiana Care Health System, Newark, DE
Teresa L Panchisin, MSN, BSN, RN, ACNS-BC , Christiana Care Health System, Newark, DE
Dannette A. Mitchell, MSN, RN, CCRN , Wilmington Hospital Intensive Care Unit, Christiana Care Health Systems, Wilmington, DE

Handout (645.9 kB)

Purpose:
Restraint use was higher then the NDNQI mean in multiple units. Information was silo'd without knowledge of what other units were doing. A restraint collaborative was formed to share best practice methods, dispel “sacred cows”, review evidence based practic, and collectively problem solve.

Significance:
Restraint use in critical care ranged from 23.08 – 53.85 throughout 2011 and 2012 quarterly data with the 2 largest ICUs in the red (above the mean) 100% of the time. Nothing seemed to be changing.

Strategy and Implementation:
A restraint collaborative was formed in September 2012 and consisted of staff from units with restraint use above the NDNQI mean. Several opportunities were found and changes made: 1. Sharing knowledge regarding a unit's success where they had gone from 100% restraint use in the immediate post operative period following open heart surgery to 0% with shorter ventilator time, decreased self-extubation, and decreased use of sedation. 2. Developing an online survey for staff to examine current baseline restraint practice. 3. Obtaining unit self-extubation rates; charts were reviewed for restraint use. 4. Sharing evidence based practice about restraint use. 5. Researching available alternative products; a new product was selected and rapidly evaluated by all the units from 12/12-3/13. 6. Providing education regarding NDNQI data. 7. Actively reviewing unit data collectively and at unit level.

Evaluation:
From November 2012 to April 2013, overall restraint prevalence rate for critical care has dropped below or close to the NDNQI mean magnet compare of 16.06% (range 8.6-17.1). Critical care was in the green (below the mean) for the first time in 1st quarter 2013.

Implications for Practice:
Decreasing restraint use and providing better alternatives could be accomplished by a small collaborative in a short amount of time. Empowering the collaborative was crucial to positive outcomes. Knowledge was a powerful key to changing the culture that “restraints were necessary”.