Physical restraint use in a Korean ICU.

Abstract

This descriptive study investigated the patterns of use of physical restraints in a Korean Intensive Care Unit (ICU) with the aim of identifying the factors that would best discriminate the times of application and removal of restraints in the same patients. The subjects of the study were 23 physically restrained patients out of 51 patients who were admitted to a medical ICU in a university hospital admitted during a 6-week period, and the 29 nurses who applied or removed the restraints. Ninety-four incidents of restraint application and removal on the 23 patients were analysed. Data were collected using a self-reporting questionnaire of attitudes towards restraint application for nurses, restraint document sheets, ICU flowsheets and patient chart reviews. Restraint-related patient data were collected on a restraint document sheet by the nurse in charge at each instance of application and removal of restraint. The most common type of restraint was the bilateral wrist restraint. The mean number of restraint applications per patient was 3.62 +/- 3.56 (mean +/- SD), and the mean restrained period per incident was 22.64 +/- 58 hours. There were no significant differences in the frequency of restraint use during the day, evening and night shifts. The most significant discriminators for restraint application and removal were the restless-behaviour score and the presence of a nasogastric tube - the classification accuracy by these two factors was 70.2%. More than 90% of the decisions to apply restraints were made by nurses. Nurses reported that preventing the patient from removing medical devices (48.6%) was the primary reason for application, and improvement of cognitive status (29.3%) was the primary reason for removal of restraint. In conclusion, as the most discriminating factor of application or removal of restraints was the patient's restless behaviour, providing nurses with tools for the accurate evaluation of patient restlessness will shorten restraint application periods in ICUs.