Prevalence, risk factors of the use of physical restraint and impact of a decision support tool: A before‐and‐after study

Author:

Dauvergne Jérôme E.1ORCID,Ferey Kim2,Croizard Véronique3,Chauvin Morgan4,Mainguy Nolwenn5,Mathelier Noeline6,Jehanno Anaëlle7,Maugars Nadège8,Badre Gaëtan9,Maze Françoise10,Chartier Marie11,Vastral Servane12,Epain Graziella13,Baudiniere Lucie14,Ronceray Mathilde15,Lebidan Mathias16,Flattres Delphine6,Ambrosi Xavier1,

Affiliation:

1. Service d'anesthésie‐réanimation, hôpital Laënnec Centre hospitalier universitaire de Nantes Nantes Cedex France

2. Service de réanimation polyvalente Centre hospitalier de Blois Blois Cedex France

3. Service de réanimation chirurgicale, hôpital Trousseau Centre hospitalier universitaire de Tours Tours Cedex France

4. Service de réanimation chirurgicale Centre hospitalier universitaire de Rennes Rennes Cedex France

5. Service de réanimation polyvalente Centre hospitalier bretagne‐atlantique Vannes Cedex France

6. Service d'anesthésie‐réanimation chirurgicale et brûlés, Hôtel Dieu Centre hospitalier universitaire de Nantes Nantes Cedex France

7. Service de réanimation Centre hospitalier bretagne sud Lorient Cedex France

8. Service de soins intensifs de pneumologie, hôpital Laënnec Centre hospitalier universitaire de Nantes Nantes Cedex France

9. Service de réanimation polyvalente Centre hospitalier de Chartres Chartres France

10. Service de réanimation chirurgicale Centre hospitalier universitaire de Brest Brest France

11. Service de réanimation chirurgicale Centre hospitalier universitaire d'Angers Angers France

12. Service de réanimation polyvalente Centre hospitalier de Saint Nazaire Saint‐Nazaire France

13. Service de réanimation chirurgicale Centre hospitalier universitaire de Poitiers Poitiers France

14. Service de réanimation neurochirurgicale Centre hospitalier universitaire de Poitiers Poitiers France

15. Service de réanimation neurochirurgicale, hôpital Bretonneau Centre hospitalier universitaire de Tours Tours Cedex France

16. Service de réanimation chirurgie thoracique et cardio vasculaire Centre hospitalier universitaire de Rennes Rennes Cedex France

Abstract

AbstractBackgroundPhysical restraint is frequently used in intensive care units to prevent patients' life‐threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool.AimsBesides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use.Study DesignA large observational, multicentre study with a repeated one‐day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect.ResultsDuring the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%–31.4%) and 25% (95% CI: 21.5%–29.1%) respectively (χ2 = 1.35; p = .24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p = .14). The patient‐to‐nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p < .001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5–10.2]).ConclusionThe prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial.Relevance to Clinical PracticeThe decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint.

Publisher

Wiley

Subject

Critical Care Nursing

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