Authors (including presenting author) :
Lam HY(1), Hou KC(1), Tsang LF(1), Wong CK(1), Kong CY(1), Cheng HC(1)
Affiliation :
(1)Department of Orthopaedics and Traumatology, United Christian Hospital
Introduction :
Once physical restraints are started to apply for patients developing delirium or with agitated behaviour, it is not easy to remove the restraints because of falls and other reasons such as self-harm. In 2019, several fall incidents related to the removal of restraint happened. There is no well-established assessment tool currently to justify if the restraints should be continued.
Objectives :
To develop a removal of physical restraint observation chart and evaluate its effectiveness in clinical settings.
Methodology :
A Literature review was conducted to explore any assessment tools for deciding the removal of physical restraint. However, no specific tools or assessment were available. According to the Hong Kong Hospital Authority, the Guidelines for the Use of Physical Restraint states that some measurements should be employed before applying physical restraint. Those principles not only adopted upon the use of physical restraint but also upon removal of physical restraint. Removal of physical restraint observation chart includes two parts.
Criteria to remove physical restraint
Firstly, a family should be present during the period of removal of physical restraint regardless of the symptoms for the necessity of being restrained. Secondly, a Decisive Wheel of Physical Restraint was composed of 4 levels divided into three sections (Hurlock-Chorostecki & Kielb, 2006). The four levels are behaviour level, device level and independence level. The three sections are reflective of the level of restraints including no restraint, alternatives and restraint. Should the patient showed either agitated behaviour, self-harm, harm to others, interrupting essential monitoring / treatment, irritable behaviour affecting others, or delirium development assessed by the Confusion Assessment Method (CAM), physical restraint would be continued.
Interventions as compulsorily required for the removal of physical restraint
Once the patient being removed of physical restraint, both the alarm pad should be used to prevent patients from falls, and regular assessment using CAM should be applied with or without family members who could accompany with the patient and putting patient within nurse station’s vicinity.
Result & Outcome :
The project was launched from 21 June 2019. As of 1 October 2019, the fall rate of UCH O&T is 0.40 in 3Q19, of which no fall incident due to removing restraint was reported. Thirteen patients were released from physical restraint using the removal of physical restraint observation chart until discharge or transfer to other ward/hospital. Three out of thirteen needed to be restrained again under regular observation and reassessment during hospitalization.
