Reducing Use of Restraints in Intensive Care Units: A Quality Improvement Project

Mitchell, Dannette; Panchisin, Teresa; Seckel, Maureen A.

doi:10.4037/ccn2018211

Cited by 21 publications

(45 citation statements)

References 20 publications

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“…Most initiatives to eliminate low-value care are mainly focused on care provided by doctors [8], but many low-value procedures are also routinely performed by nurses [4,9]. Well-known examples of low-value nursing procedures include the use of physical restraints in patients with a delirium, the use of bandages for wounds closed by primary intention, and performing a bladder washout [4].…”

Section: Introductionmentioning

confidence: 99%

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis

et al. 2020

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Background: In the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategies for these procedures. Therefore, the aim of this systematic review was to summarize the evidence of effective strategies to de-implement low-value nursing procedures. Methods: PubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched till January 2020. Additionally, reference lists and citations of the included studies were searched. Studies were included that described de-implementation of low-value nursing procedures, i.e., procedures, test, or drug orders by nurses or nurse practitioners. PRISMA guideline was followed, and the 'Cochrane Effective Practice and Organisation of Care' (EPOC) taxonomy was used to categorize deimplementation strategies. A meta-analysis was performed for the volume of low-value nursing procedures in controlled studies, and Mantel-Haenszel risk ratios (95% CI) were calculated using a random effects model. Results: Twenty-seven studies were included in this review. Studies used a (cluster) randomized design (n = 10), controlled before-after design (n = 5), and an uncontrolled before-after design (n = 12). Low-value nursing procedures performed by nurses and/or nurse specialists that were found in this study were restraint use (n = 20), inappropriate antibiotic prescribing (n = 3), indwelling or unnecessary urinary catheters use (n = 2), ordering unnecessary liver function tests (n = 1), and unnecessary antipsychotic prescribing (n = 1). Fourteen studies showed a significant reduction in lowvalue nursing procedures. Thirteen of these 14 studies included an educational component within their deimplementation strategy. Twelve controlled studies were included in the meta-analysis. Subgroup analyses for study design showed no statistically significant subgroup effect for the volume of low-value nursing procedures (p = 0.20).

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Section: Introductionmentioning

confidence: 99%

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis

et al. 2020

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“…Bu nedenle mükemmel bir hasta bakımı için, sunulan bakımın yönetimi ve tedavi süreci oldukça önemlidir (1). Kısıtlama uygulamaları ise sağlık bakım kurumlarında, özellikle YBÜ'lerde hastaların güvenliğini sağlama eğiliminde yaygın olarak kullanılan yöntemlerden biri olmakla birlikte aynı zamanda tartışmalı bir konu olarak kabul edilmektedir (2)(3)(4).…”

Section: Introductionunclassified

“…Kısıtlama kullanımı, hasta güvenliğinin tartışmasız bir gereklilik olarak kabul edilmesi gerektiği YBÜ'lerde, hasta davranışlarının zararlı olduğu ve ancak alternatif yöntemlerin hastayı ve diğerleri ni korumada yetersiz kaldığı durumlarda uygulanması gereken bir yöntemdir (3,10). Fiziksel kısıtlamanın, hastalar için etkin ve güvenilir bir yöntem olduğunu destekleyecek kanıtların yetersizliğine ve kısıtlama kullanımı ile ilişkili olası risklere rağmen, dünya genelindeki farklı YBÜ'lerde %0-90 arasında değişen bir prevalansla yaygın olarak kullanıldığı bildirilmektedir (4,(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionunclassified

“…Bununla birlikte YBÜ'lerdeki hastaların önemli bir bölümünde çeşitli derecelerde huzursuzluk, konfüzyon ve deliryum tablosunun geliştiği bilinmektedir (16,21). Bu tür hastaların, endotrakeal tüpün veya diğer tıbbi cihazların yerinden çıkmasına neden olabilecek ajite ve kontrol altına alınamayan davranışları, hastanın planlanan tedavisinin uygulanamamasına, hem kendine hem de çevresindekilere zarar vermesine, ciddi yaralanmalara, hasta düşmelerine hatta ölüme neden olabilir (1,3,16).…”

Section: Introductionunclassified

“…Kısıtlama kullanımı tedavi uygulamalarına imkan veren ve hasta güvenliğine katkıda bulunan bir uygulama olarak algılanabilir, bununla birlikte hastaya verebileceği zarar ve yarar dengesi iyi değerlendirilmesi gereken fiziksel, psikolojik, etik ve ahlaki konuları içinde barındıran karmaşık bir prosedürdür (3,8,20,22). Literatür, kısıtlama kullanımının zararlı fiziksel ve psikolojik etkileri konusunda çok sayıda kanıt sunmaktadır.…”

Section: Introductionunclassified

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Yoğun Bakım Hastalarında Kısıtlama Uygulamalarının ve Nörovasküler Etkilerinin İncelenmesi

Kısacık¹,

Cosgun²

2019

Yoğun Bakım Derg

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Introduction: The purpose of this study is to examine the characteristics of restraints applied in intensive care units and the neurovascular effects on patients to whom physical restraints are applied. Material and Methods: The cross-sectional observational study was conducted between April 2018 and September 2018 in the internal and surgical intensive care units of a state hospital. The study included 120 patients to whom physical restraints were applied. The data were collected using a data collection form developed in accordance with the literature through a review of patient records in addition to observation and interview methods. The patients under restraint were observed and the nurses responsible for patient care were interviewed. Approval for the study was granted by the Local Ethics Committee, permission was obtained from the institution and informed consent from the relatives of the intensive care units patients in the study. Data obtained in the study were analysed statistically using SPSS vn 22.0 software and descriptive statistics, the Cochran Q test, Chi-square test, Friedman test and the Kruskal Wallis test. Results: A statistically significant increase was observed in oedema and colour change in the region below the physical restraint in a 5-day observation period and pulse strength was determined to have decreased (p<0.05). No significant change was determined in the temperature and capillary filling time of the restrained area in the 5-day observation period (p>0.05). No significant difference was determined between the restraining materials used in respect of oedema and pulse strength. A statistically significant difference was determined between the restraining materials used in respect of colour change, capillary filling time and temperature parameters on the second and third days of the restricted area (p<0.05). Conclusion: The results of the study showed that in physical restraint, which is mostly preferred in intensive care units, an increase in the period of physical restraint increases the possibility of neurovascular complications and the use of special restraint equipment could reduce the potential development of neurovascular complications.

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The effect of physical restraint on neurovascular complications in intensive care units

Ertuğrul

Özden

2020

Australian Critical Care

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Reducing Use of Restraints in Intensive Care Units: A Quality Improvement Project

Abstract: Use of a restraint collaborative with subsequent adoption of restraint alternatives led to a decrease in restraint rates for the 5 intensive care units to less than the national database mean, enabled sustained success, and helped align nurses' beliefs with evidence-based practice.

Cited by 21 publications

References 20 publications

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis

Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis

Yoğun Bakım Hastalarında Kısıtlama Uygulamalarının ve Nörovasküler Etkilerinin İncelenmesi

The effect of physical restraint on neurovascular complications in intensive care units

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