Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Staff Engagement and Empowerment (motivating staff / teamwork / work revamp tackling manpower issue / staff wellness / OSH / retention)
Authors (including presenting author) :
Lee WL (1), Sze TL (1), Cheng TC Abbie (1), Tse ST (1)
Affiliation :
(1) Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital(TWEH)
Introduction :
The prevalence rate of protective restraint in TWEH increased from 7.82% in 2018 to 15.88% in 2022. 2 main indications for protective restraint were “fall prevention” and “prevention of patient tampering with medical device”. Perception of protective restraint was the main barrier in reduction restraint. Uses of protective restraints were correlated with an increased mortality, fall rate, greater cognitive decline and higher dependency in daily living. To address the limitation, a multi-approach protective restraint reduction program had been conducted
Objectives :
1. To conduct education program for the proper use of protective restraint and benefits of restraint alternatives for nurses.
2. To conduct ‘Restraint-free round’ and align the restraint practice from continuous mode to intermittent.
3. To adopt alternative measures for fall prevention and protective restraint.
4. To lead to changes in perceptions and practice of nurses regarding protective restraint in the long run.
Methodology :
A pilot study was implemented in CRU from June to December, 2023.
All patients with protective restraint were recruited while agitated and aggressive patients were excluded from the program. Three education sessions based on HKEC ‘Guidelines for Use of Physical Restraint’ for nurses was conducted. Pre and post perception survey was designed accordingly. Daily ‘Restraint-free round’ was adopted to increase times in weaning off protective restraints. Alternative measures including regular patrol round, relative involvement and new fall alarm pad model with central monitors for fall prevention were implemented.
Communication with doctors was enhanced for removal of unnecessary medical device including cardiac monitoring, heparin block and intravenous fluid to reduce the restraints’ indication. Family member had been encouraged in participation in the program and flexible visiting hour was provided.
Result & Outcome :
Results:
Total 8 nurses were recruited in the program. Significant perception change on protective restraint was found in pre- and post- comparison with average score from 6/15 to 15/15. Of which, 8 over 8 nurses perceived free protective restraint as fall risk factors before the education sessions while no nurses had same perception after the program.
Total 24 patients were recruited. Pre and post comparison was conducted. Significant increase in duration of restraint free was found. Mean duration per day increased from 2 hours to 5.5 hours. Pre-intervention fall rate (6 months before intervention) was zero while post-intervention fall rate was same which indicate restraint free was not the main causative factors for fall.
Conclusions:
To conclude, the positive result on program reflects the feasibility of education and multifactorial intervention have beneficial effects. The quality of care and close communication amongst patients/family together with the rehabilitation team could be sustained.
