best practices for nursing doc- restraint · proper identification of type of restraint acute vs...
TRANSCRIPT
Best Practices for Nursing Documentation: Restraint
Janet Jacob Robecca QuammenCorporate Director Vice PresidentClinical Informatics Consultant
2
Overview
Introduction to Florida Hospital
Restraint Definition and Documentation Requirements
Florida Hospital’s Approach
Outcomes
Benefits Realized
3
Florida Hospital
7 Campus
1792 Beds
Over 1 Million Patient Visits a Year
#1 Medicare Admissions in Country
1 of 3 Largest Heart Centers
Largest Healthcare System in Florida
5th Year in a Row—Recognized as One of America's Best Hospitals by U.S. News & World Report
4
Electronic Restraint Rollout Timeline
*Total 1792
882
50
258
100
50
155
297
BED COUNT* IMPLEMENTATIONLOCATION
August 18, 2003Orlando
2nd Quarter 2003Apopka
2nd Quarter 2003Altamonte
1st Quarter 2003Celebration
1st Quarter 2003Kissimmee
4th Quarter 2002East Orlando
3rd Quarter 2002Winter Park
5
Capture clinically relevant data
Support evidence producing informationPatient safety
Patients rights
Satisfy regulatory requirements
Provide ability for real time review
Desired Outcome
6
Any method (chemical or physical) of restricting an individual’s freedom of movement, physical activity or normal access to the body.
What is Restraint?
Each episode of restraint is documented in the medical record, consistent with organizational policies.
Restraint Documentation Standard TX.7.5.5
7
Intent Statement
Policies establish frequency, format and content of entries
Relative to each episode of restraint use
Provide clinical justification of restraint and documents clinical oversight
8
Documentation to Include
Order for use
Results of monitoring
Reassessment
Significant change in patient condition
9
Get Value to End User Quickly
User friendly
Ensure hospital policy and regulatory standards are satisfied
Provide clear direction what needs to be documented
Support real time documentation review
Increase compliance of data for trending / reporting / improvement activities
10
What Outcomes Were Realized?
Decrease in documentation errors
Increase in restraint reporting
Decrease in overall restraint usage
Identification of age cohort
Proper identification of type of restraint
Acute vs behavioral
11
Restraint Documentation Errors
0
50
100
150
200
250
300
1Q 01
2Q 01
3Q 01
4Q 01
1Q 02
2Q 02
3Q 02
4Q 02
1Q 03
Num
ber o
f Doc
umen
tatio
n Er
rors
No designation2 Types3 Types
Documentation Errors 2001–2003
12
Restraint Usage
Restraint Usage
0
0.5
1
1.5
2
2.5
1Q 01
2Q01
3Q 01
4Q 01
1Q 02
2Q 02
3Q 02
4Q 02
1Q 03
2Q 03
Usage
Even
ts/1
00 P
atie
nt D
ays
13
Restraint — Age of Patients Behavioral Restraints
Age of Patients in Behavioral RestraintsAcute Hospital
05
10152025303540
1Q 02
2Q 02
3Q 02
4Q 02
1Q 03
Num
ber o
f Pat
ient
s
< 17 18 < 25 26 < 35 36 < 45 46 < 55 56 < 65 > 66
14
Restraint — Day of Week Behavioral Restraint Initiated
0
2
4
6
8
10
12
SUNMON TUE
WED THU FRISAT
1st qtr 022nd qtr 023rd qtr 024th qtr 021st qtr 03
Day of Week Behavioral Restraint Initiated
15
Restraint — Shift of Behavioral Restraint Initiated
05
1015202530354045
1Q 022Q 02
3Q 024Q 02
1Q 03
Num
ber o
f Epi
sode
s
2300 - 06591500 - 22590700 - 1459
Shift of Behavioral Restraint InitiatedAcute Hospital
16
Provided consistent mechanism for review
Identify and reduce documentation errors
Decrease restraint usage
Identify incorrectly assigned restraint categoryAcute vs behavioral
Benefits
Identify patient cohort by age Plan alternate strategies to prevent restraint use
17
Strong project leadership
Provides consistent data for performance improvement initiatives
Well received by users
Positive response from State and regulatory agencies
Provided focus for a high risk/problem prone procedure
Supports patient safety/rights
Successes
Session # 3Best Practices for Nursing Documentation Panel
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Thank youfor attending this session.
19Physician Order — Restraint
20Physician Order — Restraint
21Monitor / Intervention — Restraint
22Physician Order — Restraint
23Monitor / Intervention — Restraint
24Date and Time — Restraint
25Documentation Results — Restraint
26Documentation Results — Restraint
27Documentation Results — Restraint