Can we justify the use of physical and mechanical restraint in pediatric patients admitted to the Intensive Care Unit?

Bosch-Alcaraz, A.; Via‐Clavero, Gemma

doi:10.1016/j.medine.2019.05.008

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…Some precautions were incorporated into the protocol for using this restriction, such as monitoring the restrictor every 2 hours to assess perfusion, skin condition. 30 …”

Section: Discussionmentioning

confidence: 99%

“…Some precautions were incorporated into the protocol for using this restriction, such as monitoring the restrictor every 2 hours to assess perfusion, skin condition. 30 In events considered rare, such as the case of UE, the monitoring of process indicators is extremely important because they change earlier with the changes than the outcome indicators.…”

Section: Discussionmentioning

confidence: 99%

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Quality improvement project to reduce unplanned extubations in a paediatric intensive care unit

et al. 2023

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BackgroundUnplanned extubations are recurrent adverse events in mechanically ventilated children and have been the focus of quality and safety improvement in paediatric intensive care units (ICUs).Local problemTo reduce the rate of unplanned extubation in the paediatric ICU by 66% (from 2.02 to 0.7).MethodsThis is a quality improvement project that was conducted in a paediatric ICU of a private hospital at the quaternary level. All hospitalised patients who used invasive mechanical ventilation between October 2018 and August 2019 were included.InterventionsThe project was based on the Improvement Model methodology of the Institute for Healthcare Improvement to implement change strategies. The main ideas of change were innovation in the endotracheal tube fixation model, evaluation of the endotracheal tube positioning, good practices of physical restraint, sedation monitoring, family education and engagement and checklist for prevention of unplanned extubation, with Plan–Do–Study–Act, the tool chosen to test and implement ideas for change.ResultsThe actions reduced the unplanned extubation rate to zero in our institution and sustained this result for a period of 2 years, totalling 743 days without any event. An estimate was made comparing cases with unplanned extubation and controls without the occurrence of this adverse event, which resulted in savings of R$955 096.65 (US$179 540.41) during the 2 years after the implementation of the improvement actions.ConclusionThe improvement project conducted in the 11-month period reduced the unplanned extubation rate to zero in our institution and sustained this result for a period of 743 days. Adherence to the new fixation model and the creation of a new restrictor model, which enabled the implementation of good practices of physical restraint were the ideas of change that had the greatest impact in achieving this result.

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“…Some precautions were incorporated into the protocol for using this restriction, such as monitoring the restrictor every 2 hours to assess perfusion, skin condition. 30 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quality improvement project to reduce unplanned extubations in a paediatric intensive care unit

et al. 2023

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Adaptation and validation of the Physical Restraint‐Theory of Planned Behaviour Questionnaire to the paediatric context

Bosch Alcaraz,

Piqueras Rodríguez,

Corrionero Alegre

et al. 2024

Nursing in Critical Care

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ObjectiveTo create and test psychometrically a paediatric version of the Physical Restraint‐Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint.DesignA psychometric study.SettingFive medical‐surgical Paeditric Intensive care Units from five hospitals in Spain.MethodsThe study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties.ResultsThe assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint‐Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75.ConclusionsThe Paediatric Physical Restraint‐Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs.Relevance for Clinical PracticeHaving this instrument will help health centres move towards restraint‐free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs.

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Can we justify the use of physical and mechanical restraint in pediatric patients admitted to the Intensive Care Unit?

Cited by 2 publications

References 8 publications

Quality improvement project to reduce unplanned extubations in a paediatric intensive care unit

Quality improvement project to reduce unplanned extubations in a paediatric intensive care unit

Adaptation and validation of the Physical Restraint‐Theory of Planned Behaviour Questionnaire to the paediatric context

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