Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Li CY(1), Chak UL(1), Lam TF(1), Tong MW(1), Wu OH(1), Leung MLG(1) and Lam YF(1)
Affiliation :
(1) Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
The prevalence rate of physical restraint was high among all the public hospitals in Hong Kong. The use of physical restraint was mainly due to fall prevention and maintenance of medical treatment. On the other hand, a decline in mobility, altered emotional status and prolonged hospital stay may be caused by the application of physical restraint. Therefore, the use of physical restraint has been a subject of ethical and clinical debate, which led to the importance of restraint reduction. This program was implementing a restraint reduction measure in the ward by different diversional interventions, which can keep patients preoccupied and improve their mental status.
Objectives :
To evaluate the effectiveness of the use of diversional interventions to reduce the use of restraint in a medical and geriatric ward.
Methodology :
A pre-test and post-test design study was performed to compare the pre-and post-intervention measurement of the use of physical restraints for the same group of transfer-in patients with the implementation of customised diversional device. The diversional devices were a companion doll, robotic cat, robotic dog, robotic bird, tangram, Chinese calligraphy and Kebbi. After the pre-intervention assessment, diversional devices would be customised according to the patient's preference and background. Physical restraints would be removed to assess the effectiveness of the intervention with a post-intervention assessment after 2 days of the intervention.
Result & Outcome :
Twenty disoriented or restless patients with physical restraint and altered behaviours were recruited for this program. The use of diversional devices resulted in 90% of the patients being free from restraints after two days of intervention. The patients had less disruptive behaviours with more stable emotional status. Two aggressive patients were able to try off the restraints for a short period but needed to reapply the restraints due to tampering with the medical device and disrupting the medical treatment.
The use of customised diversional devices according to the patient's preference was an effective intervention for restraint reduction as these measures could improve the mental status of the restrained patients with less altered behaviours. Further promotion of the concept of applying restraints only when there is a threat to the life of a patient or harmful to staff should be done with the implementation of different alternative methods.
