Authors (including presenting author) :
MY Chan, PC Ling, YM LEE, LY Lee, MK Lam, HW To, HT Chan, HY Lai, SM Leung, K Chan
Affiliation :
Department of Tuberculosis and Chest, TWGHs Wong Tai Sin Hospital
Introduction :
It is well documented that physical restraint may cause a variety of harmful psychological and physical effect to the patient. Hence, in 3Q2021, a “Restraint Free Program” was launched and aimed to promote the restraint free culture, improving patient safety, and promoting quality of care.
Objectives :
1.Build up a restrain free culture among healthcare workers(HCW) 2.Minimizing physical restraint and promote quality of care 3.Understanding the change of the clinical practice and perception of HCWs after the program by a qualitative interview
Methodology :
Restraint Free Program was implemented with proactive and collaborative strategies including “RELEASE”: (1) “Review” the restrained cases about the necessity of continuing physical restraint and discussed with staff in daily basis; (2) “Education” workshops were provided in evidence- based approach comprised of restraint free care bundle and busting some myths and misunderstandings; (3) “Leisure Corner” was designed to provide the directional activities to patients; (4) “Ensure Safety” in preventing fall incidence by collaborating with fall team and preventing incidents related to loosening of tubes/lines; (5) “Alternatives” were promoted and applied in restrained cases; (6) “Sustainability” of the program was proceeded continuously by advocating the restraint free culture; (7) “Evaluation” was conducted to identify the trend of restraint usage and to ameliorate the program. The program was carried out in 3 phases. Phase1: Appraising the HCW's perceptions, knowledge, and barriers on reduction of physical restraints use; Providing opportunity to experience of being restrained and share feelings in HCW training workshop. Phase 2: Identifying the target patients and pilot run the program in DTBC. Phase 3: Collecting the physical restraint data retrospectively, qualitative interview with HCWs after the program, comparing the knowledge level of staff and conducing the staff satisfactory questionnaire.
Result & Outcome :
The average duration of physical restraint was significantly decreased from 23.3 to 7.4 hours/ day/ restrained patient. All restrained patients had at least 1 episode of trial in discontinues physical restraint in every 24 hours. Besides, there are 3 themes identified after the qualitative interview with 7 HCWs (4 nurses and 3 patient care assistants) after the program. (1) decision of physical restraint use was changed (7HCWs); (2) staff were more willing to use other alternatives instead of physical restrain (7HCWs); (3) improving communication and relationship between staff and patient (6HCWs). In addition, the knowledge level of all staff has been improved and all of them were satisfied with the program.
