Maintaining a Safe Patient Environment Without the Use of Restraints

Purpose:
From 2007 to 2009, our restraint usage increased by 21%, at this same time we saw an increase in the fall rate by 20%, both above hospital benchmarks. The initial goal was to decrease restraints by at least 5 percent while reducing the incidence of falls and fall related injuries.

Significance:
The importance of our restraints/fall initiative was to align with EBP to utilize non-restrictive alternatives to maintain the optimum health, safety, and functional ability of our patients, while advocating for their dignity and preventing negative outcomes related to restaints/falls.

Strategy and Implementation:
The itiative began with a restraint-free trial on 1 unit. Over 3 months a 86% reduction in restraints was noted, this was the start to our hospital wide endeavor. Multidisciplinary committee meetings, intense staff education and overall leadership support were the foundation to our change. Focus was placed on EVP regarding non-restrictive alternatives as well as evaluating utilization of support staff. The standard 1:1 was changed and now included a subcategory; "FIM" frequent intermittant monitoring (a PCA rounds continually on up to 6 pts). All restraints were removed from nsg units and only a few were stored in the nsg supervisor's office. Nurses seeking a restraint had to provide evidence of alternatives utilized prior to receiving a restraint. Equipment changes included: a new callbell system, fall risk color changed to yellow, updated non-handicap toilets, & installed white boards. Intense education focused on communication of fall risk and prevention for all hospital employees.

Evaluation:
The restraint reduction initiative has decreased Acute Care restraints by 97%, Med/Surg restraints by 97%, and Critical Care restraints by 92%, and inpatient falls by 26%. Fall related injuries decreased by 20% and mod-sev fall related injures by 11%. These changes have sustained for two years.

Implications for Practice:
As stated from our nurses at the start of this initiative, “We can not stop using restraints, the patients will fall”, however, after 2 years, the culture has changed, staff will appear insulted if asked, “do you have any patients in restraints?” and will reply, “we do not use restraints here”.