Physical Restraint in Acute and Residential Care

Abstract

Aims The objective of this review was to present the best available information on the use of physical restraint in acute and residential care facilities. There were a number of specific objectives, which were to investigate a number of areas. The Use of Restraints What proportion of patients and residents are physically restrained? What is the duration of restraint for patients and residents? What physical restraint devices are used in the acute and residential care setting? Characteristics What specific patient or resident characteristics increase the likelihood of the initiation of physical restraint? Reasons Why do health care workers restrain people? Injury What proportion of patients and residents suffer restraint-related injury? What injuries do physical restraint devices cause? What injuries are caused by specific restraint devices? In addition, the review summarised recommendations and suggestions identified in the literature that addressed injury minimisation. Experience What is the experience of being restrained in an acute or residential care facility? What is the experience of having a relative physically restrained in an acute or residential care facility? Restraint Minimisation Restraint minimisation programs Do restraint minimisation programs reduce the use of physical restraint devices in the acute and residential care setting? Is there an increase in adverse events following restraint minimisation? Components of restraint minimisation programs Based on the initial investigation of the literature it was apparent that these programs had only been subject to limited evaluation. Therefore another aim of this review was to generate a description of restraint minimisation programs. This description was in terms of: • a summary of activities / interventions common to many restraint minimisation programs • a summary of the characteristics of individual restraint minimisation programs Restraint alternatives Finally, the review aimed to generate a summary of interventions or devices that may be used as alternatives to physical restraint or to reduce the need for restraint. The initial investigation of the literature suggested that few of these alternatives had been subject to any form of evaluation. Therefore this component of the review aimed to compile a list of potential alternatives. Review Methods Inclusion Criteria Studies were included in this systematic review if they met the following inclusion criteria. Types of participants This review considered all studies that involved people in an acute care or residential care institution. Types of intervention The intervention of interest was the use of physical restraints. Types of outcomes Outcomes of interest were those relating to how restraints are used, characteristics of people subject to restraint, reasons for restraining people, the impact of restraint and restraint minimisation. Types of studies This review considered a number of different types of study designs that provided valid evidence for the different review questions posed. Results Use of Restraints This review suggests that between 3.4% and 21% (a mean of 10%) of acute care patients were subject to some form of physical restraint during their period of hospitalisation. The duration of this restraint for patients ranged from a mean of 2.7 days up to 4.5 days. In the residential care setting, the proportion of residents restrained ranged from 12% to a maximum of 47% (a mean of 27%). The duration of restraint for residents, reported in a single study, was a mean of 86.5 days. However, the range in duration was from 1 day to 350 days (during a one-year follow-up period), and 32% of residents were restrained for at least 20 days each month. The findings of this section of the review highlight that a large proportion of patients and residents were subject to physical restraint. Additionally, TRUNCATED AT 600 WORDS