10645
A Nursing Collaborative: Dispeling Sacred Cows and Reducing Restraint Use
Handout (645.9 kB)
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”.