A controlled quality improvement trial to reduce the use of physical restraints in older hospitalized adults

Objectives: To implement and evaluate an evidence-informed multicomponent strategy to reduce physical restraint use in older adults admitted to acute care medical units.

Design: Stepped-wedge trial.

Setting: Four acute care medical units in Calgary, Alberta, over a 4-month time period.

Participants: Data were collected from individuals aged 65 and older present on the study units during monthly restraint audits.

Intervention: Development of opinion leaders among the nursing leadership, education and training of physicians and unit nurses, and implementation of least restraint rounds.

Measurements: The primary outcome was rate of restraint use as determined from walk-around audits. Secondary outcomes included number of physician orders for physical restraints on the electronic medical record and fall reports.

Results: Thirteen percent to 27% of individuals were being restrained on the medical units before the intervention, with the vast majority of restraints being bed rails. This decreased to 7% to 14% after the intervention. The intervention resulted in a statistically significant reduction in restraint use measured in the early mornings (P = .01), and this trend continued after adjusting for unit and month (P = .06). Similarly, the rate of restraint use trended down at all other measured time periods but was not statistically significant. A limited number of individuals had an order for physical restraint within their electronic medical record (3% before, 2% after the intervention). The median number of monthly fall reports did not change (three before, three after; P = .60).

Conclusion: A multicomponent team-focused quality improvement intervention has the potential to decrease the use of physical restraints in older hospitalized adults.