Authors (including presenting author) :
Tong MY, Chan OL
Affiliation :
Medicine and Geriatric, United Christian Hospital
Introduction :
Physical restraint refers to the use of a physical or mechanical device to limit or prevent movement of the movement of the whole or a portion of the patient’s body as a means of controlling his / her physical activities. Use of physical restraints may result in adverse physical, behavioral and psychological consequences on patients, and may raise possible ethical and legal issues. Thus, any use of physical restraint should be under the principle “use the least amount of restraint for the least duration” and used as the last resort. As cognitive decline has high prevalence among geriatric patients, these patients often shown difficulties and less able to follow medical advises, which made them more prone to be restrained during hospitalization. Random spot checking was done at an acute geriatric ward at 2 days in November 2018 to examine the use of physical restraints in ward. Among the 21 samples screened, only 3 of them had try off restraint over the last 24 hours, and near half of the cases had applied restraints for more than 48 hours. This campaign was designed to promote and remind nursing staff about the principle “use the least amount of restraint for the least duration” and to stimulate colleagues to investigate possible alternatives for restraints.
Objectives :
1. To shorten the restrain time; 2. To use the least restrictive restraint as necessary; 3. To identify possible alternative methods.
Methodology :
A 2-weeks lessen physical restraint campaign was held in ward, with all nursing staff involved. Identical briefing sessions with following suggestions were given to every nursing staff: 1) Encourage staff to try off restraint at meal time/ while sit out/ visiting hours while accompany by visitors. 2) A “Restrictive Level Scale” was designed which prioritized the commonly used restrain devices in an order according to their level of restriction towards patient’s physical mobility. Staff was encouraged to apply the least restrictive restraint according to the situation and to lower the restrictive level according to the scale once patient’s condition is under control. 3) Staff was encouraged to identify possible alternative methods and list of suggestion was provided. An extra physical restraint record was designed to record the daily condition during the period for outcome analysis.
Result & Outcome :
Total 177 sample registry (with any type of physical restraint) during the 14-days campaign, with average number of cases with physical restraint per day is ~13. High fall risk and tampering with medical devices were the 2 common reasons of application of physical restraint among these geriatric patients. Over 90% of the samples was tried off restraint in the day. Almost half of the samples (47%) were able to apply the least restrictive restraint methods only (i.e. side rail pads / pressure alarm pads / boxing gloves), while 8% were able lower the restrictive restrain level and 9% were successfully off restraint in the day. The remained 36% of them continued to apply of the same type of restraint or upgraded to more restrictive restraint method. Nurse was attempted to apply alternative methods on 1/3 of the samples to minimize physical restrain. Methods included invite carers to accompany, apply crepe bandage to IV site, apply pressure alarm pads or boxing instead, etc., with fair effect noted. Nursing staff has shown effort of to achieve the principle “use the least amount of restraint for the least duration” even in the busy working environment. A good utilization of the side rail pads, pressure alarm pads and boxing gloves was noticed in this campaign. Further discussion and information gathering should be made to explore more effective alternative methods for minimize physical restrain.
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