A non-pharmacologic approach to decrease restraint use

Abstract

Aims: To evaluate an education intervention to decrease restraint use in patients in a Trauma Intensive Care Unit (TICU) and to evaluate nurses' perceptions regarding restraints.

Objectives: To measure restraint use pre/post-intervention and to measure nurses' perceptions of restraint use.

Methods: Pre/post-intervention design to collate incidences of delirium and restraints pre/post-intervention. Data reporting nurses' views and preferences were collected pre-intervention.

Measures: Patients were assessed by nursing on admission and every shift with the Confusion Assessment Method for TICU. Restraint use was measured in a 24-hour period. Nurses' perception of restraints was measured using Perceptions of Restraint Use Questionnaire (PRUQ).

Results: A statistically significant difference was demonstrated in restraint use before and after the educational intervention. Mean and standard deviation for restraints per 1000 patient days pre-intervention was 314.1 (35.4), post-intervention 237.8 (56.4) (p=0.008). Mean PRUQ overall, 3.57 (range 1-5) indicated that nurses had positive attitudes towards restraints in certain circumstances. The primary reasons for using restraints were: "protecting patients from falling out of bed", 37 (72.5%), and "protecting patients from falling out of chair", 34 (66.7%).

Conclusion: This study demonstrates that a low risk educational intervention aimed at use of an alternative device use can reduce restraint use.

Keywords: CAM-ICU; Delirium; Nurse perception; Restraints; Sedation; Trauma Intensive Care Unit.