Abstract
BackgroundAlthough it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units.ObjectiveTo conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit’s long-term average is associated with restraint use.DesignWe analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to the unit’s average staffing across study quarters.Subjects3101 medical, surgical, and medical-surgical units in US hospitals participating in the National Database of Nursing Quality Indicators during 2006–2010. Units had to report at least one quarter with restraint use and one quarter without.Main MeasuresWe studied two nurse staffing variables: staffing level (total nursing hours per patient day) and nursing skill mix (proportion of nursing hours provided by RNs). Outcomes were any use of restraint, regardless of reason, and use of restraint for fall prevention.Key ResultsNursing skill mix was inversely correlated with restraint use for fall prevention and for any reason. Compared to average quarters, odds of fall prevention restraint and of any restraint were respectively 16 % (95 % CI: 3–29 %) and 18 % (95 % CI: 8–29 %) higher for quarters with very low skill mix.ConclusionsIn this longitudinal study there was a strong negative correlation between nursing skill mix and physical restraint use. Ensuring that skill mix is consistently adequate should reduce use of restraint.
Highlights
Physical restraint is a common, undesirable occurrence in health care.[1,2,3,4] Defined by the Centers for Medicare and Medicaid Services (CMS) as Bany manual method, physical or mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove which restricts freedom of movement or normal access to one’s body,^5 physical restraints can include belts, mittens, vests, bedrails, geriatric chairs, and other devices
Use of such devices has come under intense scrutiny, as physical restraint can result in agitation, confusion, deconditioning, pressure ulcers, strangulation, death, and adverse psychological effects.[3]
In the second analysis we modeled the odds of a unit reporting restraint use for fall prevention in a quarter
Summary
Physical restraint is a common, undesirable occurrence in health care.[1,2,3,4] Defined by the Centers for Medicare and Medicaid Services (CMS) as Bany manual method, physical or mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove which restricts freedom of movement or normal access to one’s body,^5 physical restraints can include belts, mittens, vests, bedrails, geriatric chairs, and other devices Use of such devices has come under intense scrutiny, as physical restraint can result in agitation, confusion, deconditioning, pressure ulcers, strangulation, death, and adverse psychological effects.[3] Due to these serious consequences, physical restraint use is part of public reporting for nursing homes through the CMS Nursing Home Compare website,[6] and researchers have begun to examine correlates of restraint use in various settings.[1,2,7]. Ensuring that skill mix is consistently adequate should reduce use of restraint
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