Prevalence and Variation of Physical Restraint Use in Acute Care Settings in the US

• Published in: Journal of nursing scholarship Vol. 39; no. 1; pp. 30 - 37
• Main Authors: Minnick, Ann F., Mion, Lorraine C., Johnson, Mary E., Catrambone, Cathy, Leipzig, Rosanne
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-01-2007; Blackwell Publishing Ltd
• Subjects: acute care hospitals; Acute Disease - nursing; Attitude of Health Personnel; Benchmarking; Data collection; Forecasting; Health Knowledge, Attitudes, Practice; Health Policy; Health Services Needs and Demand; Health Services Research; Hospitals; Hospitals, Urban - statistics & numerical data; Humans; Length of Stay - statistics & numerical data; Metropolitan areas; Motivation; Nursing; Nursing Assessment; Nursing Evaluation Research; Nursing Staff, Hospital - education; Nursing Staff, Hospital - organization & administration; Nursing Staff, Hospital - psychology; patient safety; Patients; Physical restraints; Prevalence; Prevention; Restraint, Physical - methods; Restraint, Physical - standards; Restraint, Physical - statistics & numerical data; Risk Assessment; Risk Factors; therapy disruption; Time Factors; Total Quality Management - organization & administration; United States; United States; United States > US; USA
• ISSN: 1527-6546; 1547-5069
• DOI: 10.1111/j.1547-5069.2007.00140.x

Purpose: To describe physical restraint (PR) rates and contexts in U.S. hospitals.
Design: This 2003–2005 descriptive study was done to measure PR prevalence and contexts (census, gender, age, ventilation status, PR type, and rationale) at 40 randomly selected acute care hospitals in six U.S. metropolitan areas. All units except psychiatric, emergency, operative, obstetric, and long‐term care were included.
Methods: On 18 randomly selected days between 0500 and 0700 (5:00 am and 7:00 am), data collectors determined PR use and contexts via observation and nurse report.
Findings: PR prevalence was 50 per 1,000 patient days (based on 155,412 patient days). Preventing disruption of therapy was the chief reason cited. PR rates varied by unit type, with adult ICU rates the highest obtained. Intra‐ and interinstitutional variation was as high as 10‐fold. Ventilator use was strongly associated with PR use. Elderly patients were over‐represented among the physically restrained on some units (e.g., medical) but on many unit types (including most ICUs) their PR use was consistent with those of other adults.
Conclusions: Wide rate variation indicates the need to examine administratively mediated variables and the promotion of unit‐based improvement efforts. Anesthetic and sedation practices have contributed to high variation in ICU PR rates. Determining the types of units to target to achieve improvements in care of older adults requires study of PR sequelae rate by unit type.