Authors (including presenting author) :
Leung SF(1),Lee WY(1), Ip CW(1), Chan H(1)(2), Tai YY(1)
Affiliation :
Medicine/Ward Glory, Haven of Hope Hospital
Introduction :
Infirmary Service is an extended care that patients are mostly dependent and required much bedside nursing care. Restraining devices, especially hand restraints are used to prevent patients from self-harm and continuationof treatment, such as preventing the pulling of Nasogastric tubes, indwelling Foley catheters and intravenous access.
Objectives :
The hand restraints involve the use of hand straps which are tied to the bed and limit the patients’ hand movement. In addition, safety hand gloves (mittens) are used to ensure the patients cannot remove the treatmentlines and self-harm. In order to minimize using hand restraint, nurses in Infirmary studied on the trial of using equipment modification and workflow standardization. The aim of the program was to reduce the use of hand restraint with the aid of educationand empowerment to the front line nurses, which in turn promotes the patients’ dignity and enhances staff’s confidence in determining the weaning off of hand restraint. The goal is to set at 30 % reduction in hand restraint in the ward in 3 months
Methodology :
Team approach (nursing) – set preliminary assessment to confirm the need for hand restraint.
Case selection – by team members, including drug review relating to sleep, mood and emotion
Collaboration – discussion with Occupational Therapist for modifying hand gloves to prevent the easy removal by patients due to the issues of standardized size. Linen department helped to modify the hand gloves.
Communication – set up protocol for weaning of hand restraint, disseminate clear message to team members. Demonstration and return demonstration of the use of modified hand gloves given to both nurses and PCAs.
Evaluation – records of the outcomes in selected cases were retrieved and a self-administered pre-and-post questionnaire was used.
Result & Outcome :
A total of 10 patients were recruited from February, 2020 to May, 2020. Among the recruited patients, 7 out of 10 had successfully used the modified hand gloves and the hand restraint was taken off, accounting toa success rate of 70%.
A total of 25 – 30% nurses (3 – 4 nurses) had expressed increased confidence in self-initiating of weaning off hand restraint. All of the participates felt being empowered to wean off the hand restraint. The programcan be further expanded to other Infirmary wards.
Recommendation
Compassion is the main theme in the program.
