Restraint minimisation in the acute neurosurgical setting

Abstract

Restraint minimisation has been successfully achieved in acute and nursing home settings over the last decade without compromising patient safety. Unfortunately these studies are limited to hospital wide results rather than specialty-specific information. The purpose of this project was to identify, report and facilitate improvements in evidenced based restraint minimisation practise in the acute neurosurgical setting of a tertiary referral centre. Pre and post audits of restraint practise were conducted, followed by feedback and practice development activities to change practice in identified areas of need. During the first audit period, 2-5/50 of all the patients within the unit in a twenty four hour period had some type of restraint related activity as part of their care. Of the total episodes of restraint related activity (n=32), 20/32 had alternatives to restraints in place and 12/32 had restraints in place. Strategies to reduce restraints were developed. This began with a review of current evidence related to restraint use and practice development activities such as group work to explore restraint related practice. The second audit period followed a program of education that included the legal and ethical issues surrounding restraint and the use of ‘individual patient special’ for patients at risk of injury. In the second audit period there were 4-10/50 episodes of restraint related activity in a 24 hour period; 24/74 had alternatives in place and 50/74 were restrained. In the final audit period, 2-6/50 of restraint-related activity in 24 hours showed 17/38 having alternatives in place and 21/38 with restraints applied. Comparison of the three audit periods indicated variation in use of restraints with greater consideration of alternatives. Initiatives such as the introduction of “restraint rounds” as a means of providing staff with expert advice followed the final audit.