Patient injury and physical restraint devices: a systematic review

Evans, David; Wood, Joanne N.; Lambert, Leonnie

doi:10.1046/j.1365-2648.2003.02501.x

Cited by 274 publications

(258 citation statements)

References 32 publications

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“…The use of restraints may exacerbate BPSD and can also lead to numerous physical problems. For example, reducing mobility through the use of bed rails can lead to an increase risk of deep vein thrombosis, pressure sores, constipation, delirium, or chest infections (Evans et al ., 2003; Inouye and Charpentier, 1996). Of the study population, 201 (87.4%) lacked the capacity to provide consent to participate in the study.…”

Section: Discussionmentioning

confidence: 99%

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

White

Leurent

Lord

et al. 2016

Int J Geriat Psychiatry

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BackgroundThe acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals.Method(s)A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave‐AD scale), as well as documentation of pharmacological prescriptions and non‐pharmacological management.ResultsThe overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p = 0.008). Non‐pharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients' admissions.ConclusionsAntipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.

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Section: Discussionmentioning

confidence: 99%

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

White

Leurent

Lord

et al. 2016

Int J Geriat Psychiatry

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“…Therefore, in order to implement the Society of Critical Care Medicine guidelines to limit the use of physical restraint, more efforts should be made to alert nursing staff on the harmful effects of using physical restraint and to suggest alternatives. 3,11 One of the strengths of our study is that the study population is a good representation of the Dutch ICU population. A large number of patients were included from 25 ICUs, creating a study sample of a quarter of all Dutch ICUs.…”

Section: Multivariate Univariatementioning

confidence: 99%

“…2 The effectiveness of physical restraint has never been studied in a randomized clinical trial, and evidence of harmful effects associated with physical restraint is increasing. In addition to local injury of the skin and peripheral nerves, 3 the use of physical restraint has been associated with risk for delirium 4,5 and posttraumatic stress disorder. [2][3][4][5][6] Furthermore, the use of physical restraint may be regarded as humiliating by awake patients and their relatives.…”

mentioning

confidence: 99%

“…In addition to local injury of the skin and peripheral nerves, 3 the use of physical restraint has been associated with risk for delirium 4,5 and posttraumatic stress disorder. [2][3][4][5][6] Furthermore, the use of physical restraint may be regarded as humiliating by awake patients and their relatives. 7,8 Although physical restraint is intended to prevent accidental removal of devices, it may actually increase agitation and accidental self-removal of endotracheal tubes.…”

mentioning

confidence: 99%

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Use of Physical Restraints in Dutch Intensive Care Units: A Prospective Multicenter Study

Kooi

Peelen

Raijmakers

et al. 2015

American Journal of Critical Care

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Background Increasing evidence indicates that harmful effects are associated with the use of physical restraint. Objectives To characterize the use of physical restraint in intensive care units. Prevalence, adherence to protocols, and correlates of the use of physical restraint were determined. For comparisons between ICUs, adjustments were made for differences in patients' characteristics. Methods A prospective, cross-sectional, observational multicenter study with a representative sample (n = 25) of all Dutch intensive care units, ranging from local hospitals to academic centers. Each unit was visited twice, and all 379 patients admitted during these visits were included and were examined for use of physical restraint. Results Physical restraint was used in 23% of all patients (range, 0%-56% for different units). Of all 346 nurses interviewed, 31% reported using a protocol when applying physical restraint. When corrections were made for clustering within units, the risk for use of physical restraint was increased in patients with delirium or coma, in patients who could not communicate verbally, and in patients receiving psychoactive or sedative medications. Sex, severity of illness, and nurse to patient ratio were not independently related to use of physical restraint. In 11 units (44%), use of physical restraint was more frequent than expected on the basis of patients' characteristics, although this finding was not significant. Conclusions Physical restraint is frequently used in Dutch intensive care units. The differences in frequency between units suggest that opportunities exist to limit the use of physical restraint.

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“…Evans et al conducted a systematic review of patient injury and physical restraint devices [6]. The researchers found that physical restraint may increase the risk of death, falls, serious injury and increased duration of hospitalization.…”

Section: Adverse Effects Of Restraint Usementioning

confidence: 99%

Use of Physical Restraints in a Rehabilitation Setting: Findings from a Point Prevalence Survey

Lai¹

2015

J Nurs Care

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A point prevalence survey among 125 patients in two units of a rehabilitation facility showed that the physical restraint rate was 12.8% (n=16). The survey examined the reason(s) for restraint use, whether its use had been explained, consent obtained and documented, whether the restraint had been appropriately applied and patients monitored during the period when restraint was applied, and whether alternatives had been attempted. Interestingly, six patients were found to have had their restraints removed either before or after the survey. A slightly less restrictive form of restraint, boxing gloves, was used for seven patients instead of limbs holders. Three patients remained restrained. The results of this study revealed that there was room for improvement in practice of restraints, and that measures to reduce the use of restraints were not necessarily very costly. Applying physical restraints is counter-productive to rehabilitative care. Nurses and other health disciplines need to be better informed regarding restraint reduction programs.

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Patient injury and physical restraint devices: a systematic review

Cited by 274 publications

References 32 publications

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

Use of Physical Restraints in Dutch Intensive Care Units: A Prospective Multicenter Study

Use of Physical Restraints in a Rehabilitation Setting: Findings from a Point Prevalence Survey

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