Prevalence and predictors of bedrail use in an acute hospital

Flatharta, Tomás Ó; Haugh, Jennifer; Robinson, Stephanie; O'Keeffe, Shaun T

doi:10.1093/ageing/afu081

Cited by 21 publications

(17 citation statements)

References 15 publications

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“…Figure 2 demonstrates the frequency of each type of restraint. The bed rails were the most common form of restraint used, confirming results in earlier publications [3]. Each type of restraint was more frequently used on the frailty ward, which may reflect the type of patient rather than a difference in practice.…”

Section: Frequency Of Restraint Usesupporting

confidence: 82%

“…Whilst distinguishable, physical restraints such as wrist restraints are rarely used unless in exceptional circumstances with sufficient justification [2], whereas less obvious forms are used on a daily basis. Examples include the use of bed rails in an attempt to keep patients within the confines of their bed space [3] or the use of an allocated healthcare assistant to make sure that the patient does not cause harm to themselves or others whilst suffering from delirium or a longstanding cognitive impairment [otherwise known as healthcare assistant specials or sitters] [4]. Therefore, there are many different types of subconscious restraints used by clinical staff, but these are often not considered to amount to “restraining the patient”.…”

Section: Introductionmentioning

confidence: 99%

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The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards—A Brief Literature Review

Gunawardena

Smithard

2019

Geriatrics

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Restraint in modern non-psychiatric-based healthcare is often regarded as a rare occurrence. It is deemed to be used as a last resort to prevent patients from directly harming themselves. However, techniques are used in modern day practice which are considered direct and indirect restraints with the justification of maintaining patient safety, but they are often not classified as “restraints”. Examples of these include the use of bed rails or tables to prevent patients from “wandering” and to reduce the risk of falls and injuries. More indirect techniques would involve passive interactions with patients or leaving mobility aids out of reach. Staff subconsciously restrain patients and reduce their liberties despite agreeing that patient autonomy should be upheld—a necessary evil to maintain a duty of care. Whilst the use of restraints is often justified to ensure patient care and prevent injury, it is not without consequence. There are physical and psychological health risks such as pressure sores from the inability to mobilise, or the brewing of anger and frustration when denied access to everyday actions. The reasons why restraints are used, whilst stemming from maintaining patient safety, are often due to low staffing levels and the inability to constantly watch at-risk patients due to a large workload. Inadequate training is another factor; by improving education in direct and indirect restraint and providing alternative methods, more ethical decisions and positive outcomes can be implemented. Healthcare professionals are reluctant to use restraint but often conduct it without realising it; assessing their understanding of restraint and providing education to raise awareness of the consequences of direct and indirect methods would result in positive steps toward reducing their use at the same time as looking to provide alternatives to uphold patient care whilst maintaining their dignity and liberty.

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Section: Frequency Of Restraint Usesupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards—A Brief Literature Review

Gunawardena

Smithard

2019

Geriatrics

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“…This is understandable as agitation is an expression of anxiety and indisposition of people with dementia and typically occurs after admission to hospital. Furthermore, agitation is often a reason for psychotropic drug use or physical restraint, and thus also negatively affects QoL 52 53…”

Section: Discussionmentioning

confidence: 99%

Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case–control study comparing a regular ward with a special care ward with dementia care concept

et al. 2019

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ObjectivesTo identify factors that predict the quality of life (QoL) of patients with dementia in acute hospitals and to analyse if a special care concept can increase patients’ QoL.DesignA non-randomised, case–control study including two internal medicine wards from hospitals in Hamburg, Germany.Setting and participantsIn all, 526 patients with dementia from two hospitals were included in the study (intervention: n=333; control: n=193). The inclusion criterion was an at least mild cognitive impairment or dementia. The intervention group was a hospital with a special care ward for internal medicine focusing on patients with dementia. The control group was from a hospital with a regular care ward without special dementia care concept.Outcome measuresOur main outcome was the QoL (range 0–100) from patients with dementia in two different hospitals. A Bayesian multilevel analysis was conducted to identify predictors such as age, dementia, agitation, physical and chemical restraints, or functional limitations that affect QoL.ResultsQoL differs significantly between the control (40.7) and the intervention (51.2) group (p<0.001). Regression analysis suggests that physical restraint (estimated effect: −4.9), psychotropic drug use (−4.4) and agitation (−2.9) are negatively associated with QoL. After controlling for confounders, the positive effect of the special care concept remained (5.7).ConclusionsA special care ward will improve the quality of care and has a positive impact on the QoL of patients with dementia. Health policies should consider the benefits of special care concepts and develop incentives for hospitals to improve the QoL and quality of care for these patients.

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“…The use of physical restraints is associated with several adverse effects, for example decreased patient well-being, increased feelings of fear, anger and discomfort, decreased mobility, increased risk of pressure ulcers and incontinence, and serious injuries (Demir, 2007;Strout, 2010). These adverse effects may have a negative impact on patients' recovery and rehabilitation and may also increase challenging behaviour of people with dementia (Bai et al, 2014;Mott, Poole, & Kenrick, 2005). Hence, guidelines recommend avoiding the use of physical restraints in general hospital settings (Lach, Leach, & Butcher, 2016;Registered Nurses' Association of Ontario, 2012).…”

Section: Introductionmentioning

confidence: 99%

Interventions to reduce physical restraints in general hospital settings: A scoping review of components and characteristics

Abraham

Hirt

Kamm

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To describe the characteristics of interventions for reducing physical restraints in general hospital settings. Background Physical restraints, such as bedrails and belts in beds and chairs, are commonly used in general hospital settings. However, there is no clear evidence on their effectiveness but some evidence on potential risks for harm. Design Scoping review. Methods We conducted a systematic database search (MEDLINE via PubMed, CINAHL, Cochrane Library; March 2020) and snowballing techniques. We included both interventional studies and quality improvement projects conducted in general hospital settings and published in English or German language. Two reviewers independently performed the study selection and data extraction. The Scoping Reviews (PRISMA‐ScR) Checklist was used. Results We included 31 articles (published between 1989 and 2018), 15 quality improvement projects and 16 intervention studies. Only five studies used a controlled design. Most studies and quality improvement projects investigated multicomponent interventions including education (predominantly for nursing staff) and additional components (e.g. case conferences). Three studies examined simple educational programmes without additional components. Conclusions A large number of multicomponent interventions for preventing and reducing physical restraints in general hospital settings have been developed. The interventions differed widely regarding the components, contents and settings. Well‐designed evaluation studies investigating the effects of such interventions are lacking. Relevance to Clinical Practice Multicomponent educational interventions might be one approach to change clinical practice, but only insufficient information is available about potential effects of these approaches.

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Prevalence and predictors of bedrail use in an acute hospital

Cited by 21 publications

References 15 publications

The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards—A Brief Literature Review

The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards—A Brief Literature Review

Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case–control study comparing a regular ward with a special care ward with dementia care concept

Interventions to reduce physical restraints in general hospital settings: A scoping review of components and characteristics

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