Learning Objective #1: Refer to an outcome on establishing a health care restraint standard by the ICU

Learning Objective #2: Understand the effectiveness of restraint application and multiply the accuracy and humaneness of health care

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In the ICU, while a patient exhibits behaviors that could be classified as irrational or uncooperative, such as attempting to seriously interfere with a physical treatment or device, such as a CVP line,tracheal tube and the like, physical restraints are frequently used on a patient in order to protect him/her from injury to self or to others, Besides establishing a number of indicators on proceeding restraint, the Joint Commission on Accreditation of Healthcare Organization (JCAHO) has also encouraged organizations to develop related polices and guidelines on helping monitor the restraint usage. Furthermore, Taiwan Quality Indicator Project (TQIP), in 1999, has also included "the use of physical restraint" as part of the acute medical care standards. Therefore, examining our restraint guidelines as well as referring to the standards of JCAHO and TQIP, we have revised our standard of operation, design a one-sheet restraint assessment and begun to evaluate after the execution in year 2003. The finding is as follows: the number of restraints dropped from 2.3% to 1.4%; more-than-24-hours restraint reduced from 91.8% to 69%; accuracy on restraint position increased from 41.8% to 100%; people injured thru restraint decreased from 31% to 0%; accuracy on the comfort degree of restraint application (i.e. how tight and loose) was up from 56.6% to 97.2%; written record appearance during restraint process extended from 4.1% to 85.4%.In conclusion, this assessment sheet has not only help scrutinized the effectiveness of restraint application, but also multiplied the accuracy and humaneness of health care during the process. As a result, it further improves the quality of health care restraints.