Changing practices to reduce patient restraints
Sentara Halifax Regional Hospital is a 192-bed hospital in South Boston, Virginia, USA. They chose DNV GL as their accreditation partner in 2015. Following its first DNV GL inspection, the hospital received a “condition level deficiency” surrounding the use of patient restraints.
The hospital had never received a similar level finding. While planning for a resolution to the issue, the team uncovered that it was not following best practice regarding evidence –based use of restraints and noted that questions surrounding the use of restraints were rarely raised.
Opportunities for improvement requiring immediate action were identified. Some patients had been restrained for weeks at a time due to several reasons listed below. Contrast that to best practice recommendations which endorse that restraints should not be used for longer than a 24-hour period, if at all, following which an MD re-assessment accompanied by MD orders are required for each subsequent day.
We also identified other practices with improvement opportunities which would require a corrective plan of action, utilizing engagement and education of the entire healthcare team, they included:
Automatically restraining intubated/ventilated ICU patients. The intent for this practice had been to eliminate the risk of self-extubation.
Patients restrained to prevent pulling out their breathing or other indwelling lines or tubes. Such an event happened on average, twice a year even with restraints in place.
- Restraint of patients experiencing withdrawal from substance abuse – this practice results in worsened outcomes in this patient population.
“That was huge”
The end results were impressive: Sentara Halifax reduced its use of restraints by 95 percent almost immediately after the changes were made. Average patient lengths of stays on ventilators also shrunk.
These potential consequences led to nearly immediate but extensive reeducation or change management with the nursing staff on the use of restraints (most such decisions are made by nurses, according to both Spence and data on the topic of restraints). Additionally, physicians wanted data on extubations in order to elicit additional buy-in for the changes in practice.
In addition, Sentara Halifax only had one extubation in all of 2016. That compared to two to three on average annually while the old patient restraints policy was in place. “That was huge,” said Nicole Spence, RN, MSN, Manager of Patient Care Services for Sentara Halifax Regional Hospital.