Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Wong CS (1)(2)(3), Kwok ML (1)(2)(3), Cheung SY (1), Woo LC (2)
Affiliation :
Shatin Hospital, (2) Cheshire Home, Shatin, (3) Bradbury Hospice
Introduction :
In the hospital, physical restraints are used only when circumstances or emergency situations involve patients who are confused or cognitively impaired or exhibit unanticipated, aggressive, violent, or destructive behavior that poses an immediate or potential danger to the safety of the patient or others. However, physical restraint can have detrimental effects on both physical and mental well-being. Extended periods of immobilization can lead to muscle weakness, pressure injuries, and respiratory complications. Moreover, the psychological impact of physical restraints can cause anxiety, depression, feelings of helplessness, and loss of dignity, hindering the rehabilitation process. Since 2008, the restraint-free culture has been promoted in the Department of Medicine and Geriatrics at Shatin Hospital. Until now, this culture has been well adopted in other departments of Shatin Hospital, Cheshire Home Shatin, and Bradbury Hospice.
Objectives :
The main objective is to sustain the physical restraint-free practice and promote patient-centered care in BBH/SCH/SH.
Methodology :
In order to support the physical restraint-free practice, modification of nursing practice and staff education are two elements to sustain.
Modification of daily nursing practice:
In BBH/SCH/SH, different diversional therapies have been adopted to divert the attention of dementia or confused patients. The therapies are provided based on patients' characteristics and interests, such as card games, mahjong, doll therapy, color filling, or calligraphy. Patients are engaged in various activities within the ward. For patients who want to go back home by travel bus, a pretend bus stop is provided and patients are asked to wait patiently. The creativity of frontline nurses and the support from supervisors help carry out these activities. Additionally, other fall preventive measures have been enhanced, including regular safety ward rounds by supporting staff and the use of fall preventive devices such as alarm sensors and alarm seat belts. For agitated patients, flexible visiting hours have been introduced, and family members' visits have been rearranged. The focus has been on empowering nurses by using alternatives to physical restraints. At the same time, a total of 10 Advanced Nurse-Aid Robots have been implemented in BBH, SCH, and SH. By promoting the use of robots in SH, the distress experienced by geriatric patients towards unfamiliar hospital environments has been significantly reduced, especially for patients with dementia.
Staff education and empowerment from CND:
In the local CND, the workgroup of fall and restraint reduction and the person-centered care workgroup further promote the culture of physical restraint-free practice to our frontline. Regular staff training and workshops are conducted for our young nurses.
Result & Outcome :
Results and Outcomes:
The restraint-free culture has been well adopted in BBH/SCH/SH, and the overall fall rates at these hospitals are significantly lower compared to the fall rate at HA (0.43 falls per 1,000 inpatient bed days occupied) and Group 2 hospital (0.27 falls per 1,000 inpatient bed days occupied). The patient fall rate of SH (General) was 0.12, BBH 0, and SCH 0.15 from 2022-23.
Conclusion:
Using physical restraints does not minimize patient fall rates. The movement towards a physical restraint-free approach represents a significant shift in our nursing team, prioritizing patient autonomy, safety, and dignity in care. By embracing alternative strategies and promoting collaborative care, rehabilitation hospitals can create an environment that supports optimal recovery, enhances patient outcomes, and upholds the fundamental rights of individuals. Staff engagement in the restraint-free approach is crucial for sustaining good practices.
