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

10.1097/jnr.0000000000000251

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

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

The Journal of Nursing Research

26卷4期（2018 / 08 / 01）

288 - 296

英文

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.

1. 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.
   連結：
2. 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.
3. Birkett, K. M.,Southerland, K. A.,Leslie, G. D.(2005).Reporting unplanned extubation.Intensive and Critical Care Nursing,21(2),65-75.
4. 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.
5. 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.
6. De Jonghe, B.,Constantin, J. M.,Chanques, G.,Capdevila, X.,Lefrant, J. Y.,Outin, H.,Group Interfaces Sédation(2013).Physical restraint in mechanically ventilated ICU patients: A survey of French practice.Intensive Care Medicine,39(1),31-37.
7. Enns, E.,Rhemtulla, R.,Ewa, V.,Fruetel, K.,Holroyd-Leduc, J. M.(2014).A controlled quality improvement trial to reduce the use of physical restraints in older hospitalized adults.Journal of the American Geriatrics Society,62(3),541-545.
8. Faul, F.,Erdfelder, E.,Buchner, A.,Lang, A. G.(2009).Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses.Behavior Research Methods,41(4),1149-1160.
9. Goethals, S.,Dierckx de Casterlé, B.,Gastmans, C.(2013).Nurses' ethical reasoning in cases of physical restraint in acute elderly care: A qualitative study.Medicine, Health Care and Philosophy,16(4),983-991.
10. Guttman, R.,Altman, R. D.,Karlan, M. S.(1999).Report of the Council on Scientific Affairs. Use of restraints for patients in nursing homes. Council on Scientific Affairs, American Medical Association.Archives of Family Medicine,8,101-105.
11. Hair, J. H.,Anderson, R. E.,Tatham, R. L.,Black, W. C.(1998).Multivariate data analysis.Upper Saddle River, NJ:Prentice-Hall International.
12. Hofsø, K.,Coyer, F. M.(2007).Part 2. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: A patient perspective.Intensive and Critical Care Nursing,23(6),316-322.
13. Hou, I. C.,Chen, J.,Lin, F. L.,Yu, H. Z.,Huang, S. F.,Huang, Y. J.(2013).The evaluation of integrating physical restraint report and care record system.Studies in Health Technology and Informatics,192,934.
14. Kandeel, N. A.,Attia, A. K.(2013).Physical restraints practice in adult intensive care units in Egypt.Nursing and Health Science,15(1),79-85.
15. Lai, C. K.,Chow, S. K.,Suen, L. K.,Wong, I. Y.(2011).The effect of a restraint reduction program on physical restraint rates in rehabilitation settings in Hong Kong.Rehabilitation Research and Practice,2011,284604.
16. Langley, C.,Schmollgruber, S.,Egan, A.(2011).Restraints in intensive care units-A mixed method study.Intensive and Critical Care Nursing,27(2),67-75.
17. Luk, E.,Sneyers, B.,Rose, L.,Perreault, M. M.,Williamson, D. R.,Mehta, S.,Burry, L.(2014).Predictors of physical restraint use in Canadian intensive care units.Critical Care,18(2),R46.
18. Mion, L. C.(2008).Physical restraint in critical care settings: Will they go away?.Geriatric Nursing,29(6),421-423.
19. Möhler, R.,Richter, T.,Köpke, S.,Meyer, G.(2012).Interventions for preventing and reducing the use of physical restraints in long-term geriatric care-A Cochrane review.Journal of Clinical Nursing,21(21-22),3070-3081.
20. Taiwan Joint Commission on Hospital Accreditation(2013).Manual of Taiwan clinical performance indicators (TCPI).New Taipei City, Taiwan, ROC:Author.

1. Yueh-Juen HWU,Feng-Yu LIN,Feng-Huang YANG(2019).The Feasibility Study of a Revised Standard Care Procedure on the Capacity of Nasogastric Tube Placement Verification Among Critical Care Nurses.The Journal of Nursing Research,27(4),1-8.
2. 謝宜珍,謝伶瑜,劉嘉惠,郭青秀,張憶潔,林姿佳,余美嬅(2020)。運用約束縮減方案照護模式於外科加護病房使用之成效。嘉基護理，20(2)，60-73。