Salamma Sabu JohnFemale Psychiatry UnitRH, Dubai

Introduction Definition Objectives Background Literature Review Strategies Implementation Outcome Challenges /Lessons Learnt Summary

Physical Restrain is a manual method that restricts freedom of movement or normal access to one’s body, contingent on maladaptive behaviours that is used when there is an imminent risk of harm to the individual or others

To improve the practice of physical restrain use in patient care

To reduce the length of stay for patients on physical restrain

To improve safety for both patients and the staff in a psychiatric unit.

 

Ms.Salamma Sabu John

Ms.Florence Okonkow Ms.Joyce Saldanha Ms.Sini Nair Ms.Felma Ison Ms.Libeth Dipasupil Ms.Jhoanna Lapez Ms.Jasmin Suico

NS-Ms.Sumini John

Physical restrain had been used as 1st resort Many patients were on physical restrain for

a longer period of time. All admitted psychiatric patients had

restrain as a PRN order!! Alternative interventions not implemented

before placing the patient on restrain. Improper restrain devices used. No standard policy & monitoring system for

physical restrain.

Non compliance to existing policy No physician orderNo documentation regarding the reason for using restrainImproper monitoring

A study conducted in Ontario, use of restraints in health care organization is restricted using least restraint, to encourage the use of alternative methods of physical restraint whenever possible.

Physical restraint should be used as a last resort ,and only when the potential benefits are greater than the potential harm secondary to the enforced immobility of restraint.

College of nurses of Ontario (2004) practice standard: restraints. Toronto,

Ontario, Canada

To minimize the risk of injury: Ensure the correct application of the

restraint device according to the manufactures recommendations.

Maintain appropriate observation during the time that a person is restrained.

Provide staff orientation and in-service education on the correct use of physical restraint devices.

Once initiated, the need for physical restrain should be reviewed regularly

THE JOANNA BRIGGS INSTITUTE , Volume 6, Issue 3, page 5, 2002

Staff orientation & education Encourage the nursing staff to use other

alternatives to avoid physical restrain use. To introduce standard restrain device To revise the current policy according to the

best practice. To reinforce the staff to comply the existing

policy. To monitor implementations – development

of KPI

Conducted Education session-consequence related to physical restrain & importance of proper monitoring & attending needs of the patient while on physical restrain.

Introduced non-physical restrain strategies like de-escalation technique, chemical restrain etc.

Introduced standard physical restrain device. Revised physical restrain policy. Monitored compliance to policy by chart audit.

Policy revised according to evidence based practice.◦ Physical restrain used as last resort◦ No PRN orders ◦ One-one observation for all patients on physical restrain.◦ Each psychiatric episode of restraint valid for 4 hrs only

Improved staff knowledge /awareness about the consequence/risk related to physical restraint.

New KPI implemented to measure the length of stay in physical restrain by each patient,(2011).

Length of time - Approval for the revised policy (multi-disciplinary policy)◦ Resistance to change from the physicians ◦ Lack of Compliance to policy from the nurses◦ Constant reinforcement & monitoring◦ New KPI monitoring for Physical Restrain

To avoid the use of Physical RestrainConduct timely assessment & reassessment- improve the clients overall status.Implement other intervention like de-escalation technique.

If Physical Restrain usedFollow organization policyOne-one observationAttend the needs of the patients Reduce the length of stay in restrain

Physical Restrain must be used as a last resort when there is an ‘imminent risk’ AND all other interventions have been applied & have proven failed