Paper
Thursday, July 14, 2005
A Naturalistic Investigation of Alternatives to Restraint Use in an Acute Care Setting
John S. Norris III, RN, MN, Critical Care, Telemetry, Medical-Surgical, Bellflower Medical Center, Kaiser Permanente, Bellflower, CA, USA, Candice Rogers, RN, BA, Quality Improvement, Bellflower Medical Center, Kaiser Permanente, Bellflower, CA, USA, and Anna Omery, RN, DNSc, Patient Care Services, Kaiser Permanente, Pasadena, CA, USA.
| Learning Objective #1: Determine the pattern of restraint use in one acute care setting |
| Learning Objective #2: Determine the relationship between the type of alternative attempted and the type of restraint use |
The goal of this study was to provide knowledge that could be used to maximize the use of alternatives to restraints and minimize the use of restraints. The objectives of this naturalistic study were to describe the pattern of restraint use, determine the relationship between the alternatives attempted and the type of restraint use, and to determine if any of a selected group of patient focused variables are predictors of the type of restraints attempted, restraint use, or complications secondary to restraints. Data for this cross sectional survey were collected from existing quality forms. These forms were completed for every incidence of restraint use from January 1, 2002 to October 31, 2004. Data analysis included descriptive, correlational, and linear regression statistics. There were 6079 restraint episodes in 1698 patients. There were 13.33 patients in restraints/1000 patient days and 47.42 episodes/1000 patient days. The most frequent type of restraint used was wrist restraints (~80%). Patients in restraints more frequently had a diagnosis of respiratory failure (8.9%) or pneumonia (6.7%). Patients were most likely to be out of restraints on the night shift (41.3%) and less likely to be out on the day shift (23.7%). While nurses used a repertoire of alternatives, observation and reorientation were the most common alternatives tried prior to restraint use across all shifts. There were no statistical relationships between the alternatives tried and type of restraint use. Age was the only statistically significant predictor with the younger the person in restraints, the more likely the alternative was tried. The results support the conclusion that nurses are using a variety of alternatives prior to the use of restraints. They need, however, a larger tool box of alternatives immediately available in the clinical setting as well as evidence as to which alternatives might be effective in specific patient types.