Hospital-Wide Restraint Initiative Committee Members Cathy Benninghoff Kathy Boyk Caryn Flournoy Kerri Rahman Ad hoc member: Deana Sievert
Vickie Geha Cathy Klotz Barb Kvale Deb Hanson Plan Current Situation Many different accreditation bodies have developed standards around the use of restraints. Most have to do with restraint reduction following the philosophy that inappropriate restraint use could result in patient
harm, including death The FDA now estimates that approximately 100 deaths per year are from restraint use Plan Improvement Goal Reduce restraint use against external benchmark throughout the hospital Use of external benchmarks as available Increase staff awareness regarding the standards, use of least restrictive
alternatives, and the goals of restraint reduction Improve documentation of restraint use Benchmarks Med/surg benchmark - 3.4
Rehab benchmark - 3.4 ICU benchmark - 24.3 Continue with internal benchmarks for psychiatric units Plan Opportunity Statement Meet compliance regarding documentation of restraint/seclusion use Maintain or decrease restraint/seclusion in all hospital areas as reasonable
Meet all compliance standards for restraint/seclusion use Measure - Indicator Various indicators were used M/S: number of restraint episodes (any time an order is written) number of patient days x 100 MCCU/Rehab: number of hours in restraints number of patient hours x 100 Child Psych: number of hours in seclusion/ restraints number of patient days x 100
Geri-Psych: number of hours in seclusion/ restraints number of patient days/24 hours x 1000 Documentation indicators Analyze - Results Geripsych is almost 100% restraint free Kobacker continues to make program changes to become restraint free Increased awareness of staff in the use of restraints
There has been some improvement in documentation, but 90% compliance is not met Actions Purchased least restrictive devices such as lap buddies, chair alarms, Velcro waist wrap, activity aprons, wedge cushions, and side-rail protectors Continue with the Family Sitter Program Use of 1:1 Added new committee members
Integrated restraint education in hospital orientation Revised the documentation tool to include all required elements Actions Added the use of freedom splints in the ICUs Changed to using an external benchmark Presented to the Med/Surgical Zone yearly Independent study program offered (contact hours provided)
Presented poster presentations Recognized staff nurses who documented thoroughly Counseling staff for documentation issues Actions Restraint care plan revised Recognized 5CD for achieving nursing documentation standards above 90% for one month Documentation tool revised Kobacker PI project won first place at
the PI fair Develop 1:1 policy Develop 1:1 Standards of Care Continue to have ACs review restraint documentation Actions Future Steps Education of physicians will occur in the area of order writing Slice/dice data further Continue to look for patterns Identify opportunities by population
or unit Continuing to educate at the new employee orientation and nursing orientation Actions Future Steps Independent studies are available Include restraint education in skills labs Continue to monitor documentation compliance regarding the many required documentation elements
Make some revisions to the current charting tools to streamline, including the physician order form Response Restraint use as it relates to PI is complex, challenging, and often, slow moving Data collection is time-consuming and labor intensive Goals must be well defined and the team must celebrate even small successes
Value and perception regarding restraint use varies, but most staff do not think about restraint use the same as a form of treatment Response When you think you have the rules down they change PI around restraint use is here to stay It is possible to achieve perfection with efforts from all
Have to keep up with the monitoring to achieve perfection
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