Development and implementation of a novel decision support tool on physical restraint use in critically ill adult patients

Abstract

Aim: To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients.

Design: A nonequivalent quasi-experimental design combined with a descriptive qualitative approach was used.

Methods: A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi-experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared.

Results: The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision-making.

Conclusions: The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision-making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree.

Keywords: adult nursing; decision-making; intensive care; multidisciplinary; restraint.