Use of physical restraints in acute hospitals in Germany: A multi-centre cross-sectional study

Abstract

BackgroundPhysical restraints are contrary to patients’ autonomy and freedom. Their justification for controlling psychomotor agitation and risk of falling is being questioned more and more often. Physical restraints are associated with many negative outcomes.The German law is explicit, allowing physical restraints in nursing only as an exception. Data on the use of physical restraints in acute hospitals in Germany are sparse. ObjectivesTo investigate the prevalence of physical restraints and characteristics associated with physical restraint use in acute hospitals. DesignCross-sectional study. Participants and setting1276 patients (mean age 65 years, 45% women, 50% surgical) on 61 wards (n=47 general; n=14 intensive care) in four acute care hospitals in North Rhine-Westphalia, Germany. MethodsOne investigator visited each hospital ward at three randomly allocated time slots on randomly selected days within a period of three months. A total of 3434 direct observations on physical restraint status were collected. The study period lasted from October 2008 to March 2009. For analysis, one time slot per patient room was randomly chosen in order to avoid repeated analysis of the same patient. ResultsThe prevalence of patients with at least one physical restraint was 11.8% (95%CI 7.8–15.7). The measures used most often were full bed rails (9.8%, 95%CI 6.5–13.1). There was pronounced prevalence variation throughout the wards (general wards: 0.0–31.3%; intensive care: 0.0–90.0%). The prevalence of physical restraints between hospitals ranged from 6.2 to 16.6%, the overall association with hospital was non-significant. Multivariate regression analysis revealed statistically significant characteristics for physical restraint use: age 80–99 years versus 18–54 years (adjusted odds ratio 4.34, 95%CI 2.18–8.64), feeding tube (2.70, 1.40–5.22), indwelling urinary catheter (6.52, 3.75–11.34), and staying in intensive care unit (3.39, 1.29–8.92). Sharing a multi-bed room (0.55, 0.35–0.89) and in situ central venous line were inversely associated (0.44, 0.19–0.98). ConclusionsPhysical restraints are apparently standard care in German acute hospitals. However, variation between wards indicates that hospital care with only few physical restraints is feasible. Respecting patients’ dignity and integrity warrants intervention programmes aimed at decreasing practice variation towards a general reduction of physical restraints in acute hospitals in Germany.