Historical analysis of siderail use in American hospitals

The effect of educational intervention on nurses' knowledge, attitude, intention, practice and incidence rate of physical restraint use

The use of physical restraint exposes patients and staff to negative effects, including death. Therefore, teaching nursing staff to develop the improve knowledge, skills, and attitudes regarding physical restraint has become necessary. A quasi-experimental pre-post design was used to evaluate the effect of educational intervention on nurses' knowledge, attitude, intention, practice and incidence rate of physical restraint in 12 wards of a hospital using a self-reported questionnaire and a restraint order form in Malaysia. The educational intervention, which included a one-day session on minimising physical restraint use in hospital, was presented to 245 nurses. The results showed a significant increase in the mean knowledge, attitude sand practice score and a significant decrease in the mean intention score of nurses to use physical restraint after intervention. There was a statistically significant decrease in the incidence rate of physical restraint use in the wards of the hospital except geriatric-rehabilitation wards after intervention.

Nursing home deficiency citations for physical restraints and restrictive side rails

This article examines whether nursing home facility-level characteristics are associated with the likelihood of receiving deficiency citations for physical restraints, including restrictive side rails. Data from the on-line survey certification of automated records were used to calculate odds ratios for facility-level characteristics associated with these deficiency citations. Repeat records from 2000 to 2007 were combined to produce longitudinal data. The results of this study show that restraint/side rail deficiency citations were negatively associated with higher staffing levels of registered nurses and licensed practical nurses (p ≤ .001) and higher Medicaid reimbursement rates (p ≤ .01). Citations were positively associated with greater nurse aide staffing (p ≤ .01) and higher quality-of-care deficiency citation percentiles (p ≤ .001). The extent of physical restraint and restrictive side rail misuse within nursing homes appears to vary according to various facility characteristics. It is less clear how internal processes within a facility bring about these observed patterns of variation.

A Longitudinal Evaluation of Restraint Reduction within a Multi-site, Multi-model Canadian Continuing Care Organization

Bien que la documentation américaine sur la réduction de l'usage des moyens de contention soit relativement importante, les travaux de recherche publiés sur cette même question sont moins nombreux sur les pensionnaires d'un établissement canadien de soins de longue durée. Les statistiques des plus importants établissements de ce type financés et exploités au Canada ont mis au jour des attitudes révélatrices envers les moyens mécaniques de contention. Durant les quatre années d'une étude comportant une campagne visant à réduire l'utilisation de moyens mécaniques de contention, la prévalence organisationnelle est passée de 24,68 % à 16,01 %. Il existait une variabilité substantielle en matière de contention parmi les 11 centres de l'organisation (échelle de 0 à 39,86 % des pensionnaires faisant l'objet de contention) et tous sauf un ont pu réduire la contention mécanique. Des facilitateurs particuliers à la réalisation et au maintien de la réduction de la contention sont indiqués, notamment les établissements de petite taille, la fourniture de soins spécialisés (par ex., maladie d'Alzheimer), et un «champion» résidant sur place. Des obstacles particuliers, comme la grande taille d'un établissement et un champion résidant à l'extérieur font aussi l'objet de discussion.

Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes

Researchers have demonstrated that the use of physical restraints in nursing homes can be reduced, particularly where advanced practice nurses (APNs) are utilized. We examined the link between APN practice, siderail reduction, and the costs of siderail alternatives in 273 residents in four Philadelphia nursing homes. The majority of participants were cognitively and physically impaired with multiple co-morbidities. APNs recommended a total of 1,275 siderail-alternative interventions aimed at reducing fall risk. The median cost of siderail alternatives to prevent falls per resident was $135. Residents with a fall history experienced a significantly higher cost of recommendation compared to non-fallers. Findings suggest that an APN consultation model can effectively be implemented through comprehensive, individualized assessment without incurring substantial costs to the nursing home.

Consequences of an intervention to reduce restrictive side rail use in nursing homes

OBJECTIVES

To examine the effect of an advanced practice nurse (APN) intervention on restrictive side rail usage in four nursing homes and with a sample of 251 residents. A secondary question explored the association between restrictive side rail reduction and bed-related falls.

DESIGN

Pre- and posttest design.

SETTING

Four urban nursing homes.

PARTICIPANTS

All nursing home residents present in the nursing home at three time points (n=710, 719, and 707) and a subset of residents (n=251) with restrictive side rail use at baseline.

INTERVENTION

APN consultation with individual residents and facility-wide education and consultation.

MEASUREMENTS

Direct observation of side rail status, resident and nurse interview for functional status, mobility, cognition, behavioral symptoms, medical record review for demographics and treatment information, and incident reports for fall data.

RESULTS

At the institutional level, one of the four nursing homes significantly reduced restrictive side rail use (P=.01). At the individual participant level, 51.4% (n=130) reduced restrictive side rail use. For the group that reduced restrictive side rails, there was a significantly (P<.001) reduced fall rate (-0.053; 95% confidence interval (CI)=-0.083 to -0.024), whereas the group that continued restrictive side rail did not demonstrate a significantly (P=.17) reduced fall rate (-0.013; 95% CI=-0.056-0.030).

CONCLUSION

An APN consultation model can safely reduce side rail use. Restrictive side rail reduction does not lead to an increase in bed-related falls. Although side rails serve many purposes, routine use of these devices to restrict voluntary movement and prevent falls is not supported.

Development and Testing of Tools to Assess Physical Restraint Use

BACKGROUND

To implement best practice in restraint use, healthcare providers and decision makers require current, accurate, and easily accessible information about restraint practices in their setting. There is a need for a reliable and valid instrument that is feasible for use in these settings to rapidly assess physical restraint use.

METHOD

Two instruments to assess physical restraint use were developed and tested: an observation tool and a chart audit. The instruments were tested in complex continuing care units and rehabilitation units at two healthcare organizations. The restraint use observation tool was administered by trained observers in a series of five observations over a 2-week period. Chart audits were conducted for a sample of residents. Inter-rater agreement of the observation tool and chart audit was assessed. Point prevalence estimates were obtained for each site. The time required to use the observation tool and complete chart audits as well as the comparability of findings from the two data sources were described.

FINDINGS

Restraint use observations were completed for 289 patients and chart audits were completed for 207 patients. Prevalence and patterns of restraint use varied between sites and across time periods. Observations took an average of 2.6 (Site A) and 0.6 (Site B) minutes per patient. There was excellent inter-rater agreement for most items on the observation tool with the exception of whether or not the patient was able to release or loosen the restraint. There was significant concordance but as expected, not complete agreement between paired estimates of prevalence using the observational tool and the chart audit.

CONCLUSION

The observation and chart audit tools are feasible to use and reliably assess physical restraint use in healthcare organizations. The patient's physical capacity to move independently, the patient's waking status, and the restraint's restriction of mobility are items that should be added to the observation tool. The tools are complementary and should be used in tandem to capture the multifaceted complexity of restraint use in health service organizations.

Patient Choice: An Influencing Factor on Policy-Related Research to Decrease Bedrail Use as Physical Restraint

BACKGROUND

This paper shows patients' enactment of choice in mixed methods, multidisciplinary study on the use of bedrails as restraints.

APPROACH

Under the pressure of the implementation of impending legislation, patients from a Canadian elderly care rehabilitation unit were recruited to be part of this study and assigned to either a study or control group. Study group patients were exposed to a new facility policy on restraints in which bedrails were not to be used on a patient's bed except under specified conditions. Patients in the control group continued to have bedrails on a routine basis according to the facility's old policy. Following group assignments, patients could choose to crossover to either the control or study group based on their opinions about bedrails.

FINDINGS

After patients crossed over into either the study or control group, findings for the new groups differed significantly. Participants in the rails-up group had lower admission Functional Independence Measure scores (p = .001) and higher admission Cumulative Illness Rating scores (p = .000) compared to those in the rails-down group.

CONCLUSIONS

Patients have specific concerns related to the use of bedrails that might affect implementing bedrail minimization policies. Additionally, the authors conclude that patients' input into research design may increase patients' support of the protocol and help maintain study integrity.

Falls in an acute hospital and their relationship to restraint use

BACKGROUND

Patient falls are a common complication of hospitalisation. Use of restraints in patients who are perceived to be at risk for falling may lead to injury and even death.

AIMS

To determine the frequency of falls and fall-related injuries and the contribution of restraints in a hospital population.

METHODS

We analysed incident reports of falls for a single year from a large teaching hospital. Results The fall rate per 10,000 patient days was 13.2 (95%CI 11.6-14.8). Fall rate increased dramatically with increased age. Eighty-two (30.7%) falls resulted in injury, of which 6 (7.3%) were serious. Injuries occurred in 71/247 (29%) unrestrained falls and in 11/20 (55%) falls in patients who were restrained. Injuries were more severe in falls with restraints in place (p < 0.0001).

CONCLUSIONS

Restraint use is associated with increased severity of injury in hospital patients who fall.

Integrating nursing history into the curriculum

Understanding nursing history helps us to comprehend current issues in nursing and anticipate future trends in the profession. Faculty need strategies that will assist them in making history meaningful in the crammed, packed undergraduate and graduate curricula. This article examines how nursing history has been taught in the curriculum since the National League of Nursing Education first introduced a standardized curriculum in 1917 until the present. It explores the teaching strategies used in the past and expands on some of these methods and strategies in order to include them in nursing curricula today.

Minimizing the use of restrictive devices in dementia patients at risk for falling

The accumulating empirical evidence demonstrates that restrictive devices can be removed without negative consequences. Most importantly, use of nonrestrictive measures has been correlated with positive patient outcomes and represents care that is dignified and safe for confused elders. Most of these nonrestrictive approaches promote mobility and functional recovery; however, testing of individual interventions is needed to further the science. As the research regarding restrictive devices has been translated into professional guidelines and regulatory standards, the prevalence of usage has declined dramatically. New institutional models of care discouraging routine use of restrictive devices also will foster innovative solutions to clinical problems associated with dementia.