Factors associated with mechanical restraint in the hospital environment: a cross-sectional study

Abstract

Objective: To estimate the prevalence of mechanical restraint in the hospital environment and the factors associated with its performance. Method: A cross-sectional, observational study with patients from a public hospital from the medical clinic, surgical clinic and intensive care unit evaluated by descriptive, univariate and multivariate analyses. Results: One hundred eleven (111) patients participated in the study. The prevalence of mechanical restraint was 51.4%; bilateral rails on the bed were used in 100% of the restraints, and bilateral wrist restraints were also observed in 29.8%. The most common justifications were the risk of falls (100.0%) and the risk of non-scheduled removal of invasive devices (57.9%). The restrained patients differ significantly from those not restrained by the following associated factors: male gender; age; stroke diagnosis; the hospitalization unit; ambulation capacity; the use of sedative medication; and the use of invasive devices. Conclusion: This study estimated a high mechanical restraint prevalence in the hospital environment and determined factors associated with the risk of a patient being restrained. A medical restraint evaluation team is recommended for an in-depth analysis of indication and therapy.

Overcoming the Use of Mechanical Restraints in Psychiatry: A New Challenge in the Everyday Clinical Practice at the Time of COVID-19

“…Further, in surgical patients, the post-operative course may be complicated by confusion and agitation with the risk of falls. However, MR's most common reason is to avoid taking away invasive or bothering devices [19]. PR and MR are also used in emergency departments (ED), and the Joint Commission and Centers for Medicare & Medicaid Services has realized procedures aimed at limiting the use of such procedures in US hospitals (42 CFR Part 482).…”

Contenção mecânica nos serviços de urgência e emergência

“…It is known that the use of restraint is a practice historically used in hospital environments, with greater frequency in elderly patients, even in the absence of evidence of its benefit. 1 It is inferred that, although there are several types of containment, such as physical, mechanical, pharmacological or environmental, mechanical containment is the most frequently described in the literature, being defined as any method that prevents or limits the actions of a person through the use of materials or devices attached to the individual's body. [1][2] Examples of this type of containment include: wrist or ankle immobilizers; side grids; abdominal straps; containment strips.…”

“…1 It is inferred that, although there are several types of containment, such as physical, mechanical, pharmacological or environmental, mechanical containment is the most frequently described in the literature, being defined as any method that prevents or limits the actions of a person through the use of materials or devices attached to the individual's body. [1][2] Examples of this type of containment include: wrist or ankle immobilizers; side grids; abdominal straps; containment strips. [1][2] It is understood that hospitalization is a triggering factor of damage to patients, and the main factors associated with restraint are: pressure and friction injuries; immobility; circulatory problems; infections; patient discomfort; incontinence; disorientation; agitation or delirium and increased risk of extubation.…”

“…[1][2] Examples of this type of containment include: wrist or ankle immobilizers; side grids; abdominal straps; containment strips. [1][2] It is understood that hospitalization is a triggering factor of damage to patients, and the main factors associated with restraint are: pressure and friction injuries; immobility; circulatory problems; infections; patient discomfort; incontinence; disorientation; agitation or delirium and increased risk of extubation. 1,[3][4][5][6] The greatest aggravation of this procedure occurs due to reports in the literature of strangulation, asphyxiation or compression that resulted in death.…”

“…[1][2] It is understood that hospitalization is a triggering factor of damage to patients, and the main factors associated with restraint are: pressure and friction injuries; immobility; circulatory problems; infections; patient discomfort; incontinence; disorientation; agitation or delirium and increased risk of extubation. 1,[3][4][5][6] The greatest aggravation of this procedure occurs due to reports in the literature of strangulation, asphyxiation or compression that resulted in death. 7 It is added that falls are among the biggest causes of adverse events related to containment and are responsible for two out of five events related to the patient's health, this is because the contained patient is agitated in an attempt to fight the containment, which increases the risk of muscle breakdown and even rhabdomyolysis.…”