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Observational Study
. 2024 Sep;29(5):987-996.
doi: 10.1111/nicc.12945. Epub 2023 Jul 3.

Prevalence and risk factors of the use of physical restraint and impact of a decision support tool: A before-and-after study

Jérôme E Dauvergne  1 , Kim Ferey  2 , Véronique Croizard  3 , Morgan Chauvin  4 , Nolwenn Mainguy  5 , Noeline Mathelier  6 , Anaëlle Jehanno  7 , Nadège Maugars  8 , Gaëtan Badre  9 , Françoise Maze  10 , Marie Chartier  11 , Servane Vastral  12 , Graziella Epain  13 , Lucie Baudiniere  14 , Mathilde Ronceray  15 , Mathias Lebidan  16 , Delphine Flattres  6 , Xavier Ambrosi  1 ; ATLANREA Group
Collaborators, Affiliations
Observational Study

Prevalence and risk factors of the use of physical restraint and impact of a decision support tool: A before-and-after study

Jérôme E Dauvergne et al. Nurs Crit Care. 2024 Sep.

Abstract

Background: Physical restraint is frequently used in intensive care units to prevent patients' life-threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool.

Aims: Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use.

Study design: A large observational, multicentre study with a repeated one-day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect.

Results: During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%-31.4%) and 25% (95% CI: 21.5%-29.1%) respectively (χ2 = 1.35; p = .24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p = .14). The patient-to-nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p < .001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5-10.2]).

Conclusion: The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial.

Relevance to clinical practice: The decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint.

Keywords: decision support tool; intensive care unit; nursing care; physical restraint; prevalence.

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References

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