Authors (including presenting author) :
Soo AKW, Wong KKY, Lam DCM, Cheung SHM, Cheung JTY
Affiliation :
Occupational Therapy Department, Tuen Mun Hospital
Introduction :
Physical restraint can cause various injuries, minor or severe, resulting in increasing health care cost or even fatal consequences. The prevalence of physical restraint use in nursing homes varies more than five-fold across different countries, from an average of 6% in Switzerland to 9% in the US, 20% in Hong Kong, 28% in Finland, and over 31% in Canada (Feng et al., 2009). In a local project conducted by Community Geriatric Assessment Service (CGAS) covering 82 old-aged homes in New Territories West Cluster in 2013, it was found that 42% of residents got restrained. Reducing restraint is one the many goals of health care for increasing concern by health care workers.
Objectives :
To study the effect of activity-based restraint reduction program in a rehabilitation in-patient setting
Methodology :
This study aimed to evaluate the effectiveness of a newly implemented restraint reduction program in a medical convalescent ward in Tuen Mun Hospital. All patients admitted with physical restraint applied were recruited. Pre-and post-intervention data were collected. Type of and reason for restraint, duration of application, cognitive and activity of daily living (ADL) function were assessed. Occupational therapist will tailor-made intervention after individualized assessment. Antecedent-Behaviour-Consequence approach was used to analyze the reason for restraint. Person-Environment-Occupation approach was employed in treatment design. Treatment included cognitive training & stimulation, ADL and functional training, activity engagement, protective aids prescription, positioning intervention, group training, caregiver education and environmental modification. Occupational therapists, doctors and nurses held weekly bedside meeting to review patients’ condition. Periodic review meetings were conducted for program enhancement.
Result & Outcome :
A total of 125 patients were recruited from 1 Dec 2018 to 30 Nov 2019. Mean age was 77.7. All male. Reasons for restraint mainly included interference with life-supporting device, risk of fall, and behavioral problem. At admission, types of physical restraint included limb holder (29.6%), safety vest (22.4%), hand mitten (6.4%) and combination of the above (41.6%). Thirty-five (28%) patients received chemical restraint during in-patient stay or upon discharge. Upon discharge from hospital, 45 (36%) patients were restraint free, 63 (50.4%) decreased total number of restraints and 83 (66%) could successfully downgrade the mode of restraint. Eighty-eight (70.4%) patients were able to be restraint free during occupational therapy sessions and 59 (47%) patients could decrease the duration of restraint application. With targeted interventions, improvements were also shown in cognition (abbreviated mental test (AMT)) score = admission 3.02 vs. discharge 4.22, mean change 1.195±2.75 (p< .01) and functional outcome (modified Barthel index (MBI)) = admission 22.02 vs. discharge 27.72, mean change 5.969±11.18 (p< .001). No fall incident was noted in this study group.
Restraint reduction program showed positive effect in reducing physical restraint in a medical convalescent in-patient setting. Patient-centered individualized activities intervention, least restraint approach, respecting patient comfort and dignity, on-going evaluation and follow-up, and multidisciplinary involvement contributed to the success of the program.
