A Multidisciplinary Program Reduces Over 24 Hours of Physical Restraint in Neurological Intensive Care Unit

Yu-Li LIN; Cheng-Chih LIAO; Wen-Pin YU; Tsung-Lan CHU; Lun-Hui HO

doi:10.1097/jnr.0000000000000251

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A Multidisciplinary Program Reduces Over 24 Hours of Physical Restraint in Neurological Intensive Care Unit

Yu-Li LIN ； Cheng-Chih LIAO ； Wen-Pin YU ； Tsung-Lan CHU ； Lun-Hui HO

The Journal of Nursing Research ； 26 卷 4 期 (2018 / 08 / 01) ， P288 - 296

英文 DOI： 10.1097/jnr.0000000000000251

multidisciplinary collaboration ； intensive care unit ； neurological care ； patient safety ； physical restraint

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摘要 │ 参考文献 (20) │ 被引用文献 (2) │ 国际计量

摘要〈TOP〉

Background: Physical restraint (PR) has to be performed in a well-organized, structured, and careful manner. The safety and effectiveness of the PR procedure in clinical practice are crucial to patient care. Purposes: The aim of this study was to examine the effect in neurological intensive care units of a multidisciplinary PR reduction program on the overall incidence rate of PR, the monthly rate of PR, and the monthly rate of PR of more than and less than 24 hours, respectively, after controlling for associated factors. Methods: A before-and-after study design was conducted in three neurological intensive care units (total of 45 beds) of a medical center in northern Taiwan. A multidisciplinary PR reduction program was implemented, with four phases of data collection. Data on the number and duration of PR were extracted from a database. In the first preintervention phase, data on the rate (number or frequency) and duration of PR were collected for 12 months before program implementation. The next three data collection phases were 1 month (introduction), 3 months (intermediate), and 6 months (maintenance) after program implementation. The chi-square test, one-way analysis of variance with Scheffe’s post hoc tests, and logistic regression method were used for data analysis. Results: The results showed that PR was used 72.8 mean times per month before program implementation. After implementation, the mean times per month fell to 40 after the first postimplementation month (introduction), 53.3 after 3 months (intermediate), and 36.2 after 6 months (maintenance). Implementation of the PR reduction program resulted in a decreased incidence rate of PR from 6.1% to 3.2% (event/total patient day) and a decrease in the percentage of patients who were restrained for more than 24 hours from 69.6% to 34.1%. The results of the logistic regression model showed that PR of more than 24 hours was significantly less in the postintervention phases: introduction phase (odds ratio [OR] = 0.31), intermediate phase (OR = 0.16), and maintenance phase (OR = 0.18). Moreover, PR of more than 24 hours was significantly higher in patients with endotracheal intubation (OR = 1.51) and nasogastric intubation (OR = 2.16) and with Glasgow Coma Scale scores of 6Y8 (OR = 2.36), 9Y12 (OR = 2.40), and 13Y15 (OR = 2.15). Conclusions/Implications for Practice: The results support that a multidisciplinary collaborative program has the potential to decrease the incidence of PR in neurological intensive care units. A standardized protocol and policies are essential for healthcare professionals to effectively use PR as well as to effectively improve the quality of care that is provided to intensive care patients.

参考文献 ( 20 ) 〈TOP〉

Chang, Y. Y.,Yu, H. H.,Loh, el-W.,Chang, L. Y.(2016).The efficacy of an in-service education program designed to enhance the effectiveness of physical restraints.The Journal of Nursing Research,24(1),79-86.
连结：
Benbenbishty, J.,Adam, S.,Endacott, R.(2010).Physical restraint use in intensive care units across Europe: The PRICE study.Intensive and Critical Care Nursing,26(5),241-245.
Birkett, K. M.,Southerland, K. A.,Leslie, G. D.(2005).Reporting unplanned extubation.Intensive and Critical Care Nursing,21(2),65-75.
Bleijlevens, M. H.,Wagner, L. M.,Capezuti, E.,Hamers, J. P.,International Physical Restraint Workgroup(2016).Physical restraints: Consensus of a research definition using a modified Delphi technique.Journal of the American Geriatrics Society,64(11),2307-2310.
da Silva, P. S.,Fonseca, M. C.(2012).Unplanned endotracheal extubations in the intensive care unit: Systematic review, critical appraisal, and evidence-based recommendations.Anesthesia & Analgesia,114(5),1003-1014.

被引用文献 ( 2 ) 〈TOP〉

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