Authors (including presenting author) :
Chan WY, Wong MY, Lai CW, Shi NM, Mak CK, Yeung YM
Affiliation :
Department of Rehabilitation and Extended Care, Tung Wah Group of Hospitals Wong Tai Sin Hospital
Introduction :
Physical restraints refer to any devices or material attached or adjacent to an individual’s body that he/she cannot easily remove, thus immobilizes, or reduces the ability of the individual to move his/her body parts freely. The use of physical restraints is common in HK public hospitals. 56.3% of applying restraint is to prevent interruptions of therapeutics devices, such as IV access and oxygen therapy. Putting on restraints for protecting from fall contributes to 25%. However, research showed that restraint use did not prevent fall, but increased fall rate and increased the severity of injury when fall. Overuse of physical restraints is associated with potential risk in both physical health and mental health. For examples, risk of physical health considers as developing pressure injury and decreasing in muscle strength whereas risk of mental health considers as developing delirium and declining in cognitive function. Physical restraints are commonly utilized to ‘protect’ patients; however, it is not effective and harmful to patients. Therefore, restraint reduction program (REsTRAIN program) is introduced to reduce the use of physical restraint.
Objectives :
1) To reduce the restraint prevalence, intensity, and multiple restraint use
2) To promote the use of less restrictive restraint types in patients
Methodology :
There were two phases of the restraint reduction program (REsTRAIN program). Phase 1 was senior nurse–facilitated restraint rounds. Restraint rounds on each restrained patient were emphasized in every-shift by shift supervisors. It required critical thinking in reassessment of the restraint indication and evaluation of the needs. Suggestions were provided to team nurses by seniors to release restraints or change to less restrictive. Phase 2 was educational intervention. The alternative measurements suggested by HAHO were educated. The details in alternative measurements, such as diversional activities and de-escalating technique, were covered. Also, different types of restraints in different intensity levels were introduced. Moreover, real cases discussion was involved to allow colleagues to discuss in groups and apply the strategies learnt in the educational intervention. And the strategies were demonstrated by video with animation to show how to apply the techniques practically and reinforce the concepts of restraint-free.
Before the restraint reduction program, the baseline data was collected at selected ward from 30/7/2022 to 5/8/2022. After obtaining the baseline data, the program was implemented and lasted for 2 months. The senior nurse–facilitated restraint rounds were emphasized and the educational intervention was held. After the program, data was collected again in October. The outcome variables, such as restraint prevalence, restraint duration and restraint intensity, were obtained. Furthermore, staff feedback on the program was also collected.
Result & Outcome :
Comparing the data between pre-intervention and post-intervention, the restraint prevalence was reduced from 34% to 22%. For the restraint duration, 100% of restrained patients were being restrained for whole day without try off before the program. The duration of patients being restrained was reduced to 16 hours after the program and 34% of them could be discontinued from restraint or being restrained intermittently. For the restraint intensity, more restrictive restraints, such as upper limbs holders, were frequently used (52%) among all the episodes of physical restraints before attending the program. After the program, patients were restrained by upper limbs holders decreased to 11% while restrained by mitts, which was less restrictive, increased to 52%. Apart from improvement in the situation of restraint use on patients, nursing staffs had positive feedback on the program. They understood more about how to execute the alternatives. And their job satisfaction was increased as they can promote patients’ quality of life.
To conclude, REsTRAIN program combined with a regular restraint round and an educational program for nurses was effective. It could reduce the restraint prevalence and shorten the duration. Even if physical restraints were needed, nursing staffs would start from less restrictive restraints first to maximize patients’ movement.
