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

Abstract

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.

Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit

“…Researchers identified variation in the types of physical restraint applied, with the majority using commercial wrist or other limb restraints, whilst one unit used gauze bandages to tie patients' wrists (Kandeel & Attia, 2013). There was also a lack of standardisation of chemical restraint, with a variety of drugs administered, including Haloperidol (Luk et al, 2014;MacSweeney et al, 2010), opiates (Fraser et al, 2000) and benzodiazepines (van der Kooi et al, 2015;Luk et al, 2014). Participants in multidisciplinary focus groups held by Palacios-Cena et al (2016) and Kydonaki, Hanley, Huby, Antonelli, and Walsh (2019) described the lack of standardised and evidencebased agents for the management of agitated or delirious patients.…”

“…Variations were also found between different hospitals. In Canada, university-affiliated hospitals used fewer physical restraints (Luk et al, 2014), whilst 0%-56% of ICU patients were restrained in the Netherlands (van der Kooi et al, 2015).…”

“…Behavioural attributes associated with the application of physical or chemical restraint are summarised below (Table 3). Agitation was cited as the primary reason for restraint; however, sedation and drowsiness were also identified (Benbenbishty et al, 2010;van der Kooi et al, 2015). Subjective descriptors of behaviour appeared more likely to trigger the use of restraint than the use of validated tools (Luk et al, 2014;Micek et al, 2005;Svenningsen et al, 2013).…”

Effectiveness of Multifactorial Intervention on Observance of Physical Restraint Standards of the Patients Hospitalized in Intensive Care Units

“…The main reason is to protect the patient from falling (10)(11)(12)(13). The extent of using physical restraint in the ICUs is 24% -40% higher than that of the general units (1). Although there is the primary tendency to use physical restraint to protect the patient, many negative and harmful effects of its use are reported (14).…”

“…One of the important duties of nurses is to protect patients against any injuries (1)(2)(3). This issue can be a challenge for the nurses of intensive care units (ICUs) who should create an immune environment for patients with agitation and delirium (4).…”