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A Controlled Quality Improvement Trial to Reduce the Use of Physical Restraints in Older Hospitalized Adults.
J Am Geriatr Soc. 2014 Feb 12;
Authors: Enns E, Rhemtulla R, Ewa V, Fruetel K, Holroyd-Leduc JM
Abstract
OBJECTIVES: To implement and evaluate an evidence-informed multicomponent strategy to reduce physical restraint use in older adults admitted to acute care medical units.
DESIGN: Stepped-wedge trial.
SETTING: Four acute care medical units in Calgary, Alberta, over a 4-month time period.
PARTICIPANTS: Data were collected from individuals aged 65 and older present on the study units during monthly restraint audits.
INTERVENTION: Development of opinion leaders among the nursing leadership, education and training of physicians and unit nurses, and implementation of least restraint rounds.
MEASUREMENTS: The primary outcome was rate of restraint use as determined from walk-around audits. Secondary outcomes included number of physician orders for physical restraints on the electronic medical record and fall reports.
RESULTS: Thirteen percent to 27% of individuals were being restrained on the medical units before the intervention, with the vast majority of restraints being bed rails. This decreased to 7% to 14% after the intervention. The intervention resulted in a statistically significant reduction in restraint use measured in the early mornings (P = .01), and this trend continued after adjusting for unit and month (P = .06). Similarly, the rate of restraint use trended down at all other measured time periods but was not statistically significant. A limited number of individuals had an order for physical restraint within their electronic medical record (3% before, 2% after the intervention). The median number of monthly fall reports did not change (three before, three after; P = .60).
CONCLUSION: A multicomponent team-focused quality improvement intervention has the potential to decrease the use of physical restraints in older hospitalized adults.
PMID: 24517583 [PubMed - as supplied by publisher]