A Restraint Alternative Program on the Neurotrauma Intermediate Care Unit

Abstract

Problem & Purpose: Restraint use has been associated with risks to patient safety, including physical injury, cognitive and functional impairment, agitation and delirium, increased psychological distress for patients and family, and even death. The Joint Commission, Centers for Medicare and Medicaid Services, and the American Nurses Association all support the reduction of restraint use in order to improve patient safety. On a Neurotrauma Intermediate Care (IMC) unit at an urban, academic medical center, the prevalence of restraint use is consistently higher than the National Database of Nursing Quality Indicators mean. The purpose of this quality improvement project is to implement an evidence-based restraint alternative program consisting of a Restraint Decision Wheel, improved restraint alternative supply, and charge nurse restraint rounding in order to reduce restraint prevalence on the Neurotrauma IMC Unit. Methods: Improvements in restraint alternative supply, provision of the Restraint Decision Wheel, and charge nurse restraint rounds were implemented on the unit. Staff training was provided on restraint alternatives and use of the Restraint Decision Wheel. The project champion team met twice monthly to strategize improvements to project implementation. Data were collected to evaluate adherence to process changes through electronic health record audits, survey, and restraint rounding forms. Outcome and balancing measures tracked included restraint prevalence and unintentional device removal. Data were analyzed using run charts. Results: Restraint prevalence was variable throughout the early weeks of the project, but a non-random pattern was demonstrated by project completion with a shift of 6 consecutive points below the median. The median Restraint Decision Wheel Utilization was 43% and charge nurses rounded a median 21% of shifts per week. 10 unintentional device removal occurrences were reported during the project. Conclusions: Implementation of the restraint alternative program was associated with a significant decrease in restraint prevalence. Use of the Restraint Decision Wheel was incorporated into practice more frequently than charge nurse rounding. No significant safety events occurred from unintentional device removal. Overall, implementation of a restraint alternative program is a low-cost, safe, and effective intervention for reducing restraint prevalence.