Restraint use in inpatient rehabilitation: incidence, predictors, and implications.
The use of mechanical restraints in rehabilitation facilities focuses attention on the conflict between patient safety and independent physical function. To evaluate restraint use, we reviewed records of 323 inpatient rehabilitation admissions. Restraint orders were written for 78.3% of admissions, but used in only 32.2% of cases (mean duration of use was 16 days). Posey vests were most commonly used (78.2%). Reasons for restraint were previous fall (26.8%), impulsivity (23.7%), and inappropriate self-transfers (19.6%). Male sex, decreased mental status, low admission functional independence measure (FIM) score, stroke, or traumatic brain injury were closely associated with restraint use. Falls occurred in 25% of restrained and 10.1% of unrestrained patients. Conclusions are as follows: (1) although physician orders are required to apply restraints, nursing staff initiate, monitor, and discontinue restraint use independently; (2) traumatic brain injury or stroke, decreased admission mental status, lower FIM scores, and male sex are indicators of restraint use; (3) age is not associated with restraint use; and (4) restraints may not prevent falls.
Schleenbaker
R E
RE
Cardinal Hill Rehabilitation Hospital, Lexington, KY.
McDowell
S M
SM
Moore
R W
RW
Costich
J F
JF
Prater
G
G
D000058:Accidental Falls; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000451:nursing / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D003221:Confusion / Q000451:nursing / Q000534:rehabilitation; D006259:Craniocerebral Trauma / Q000451:nursing / Q000534:rehabilitation; D005260:Female; D006743:Hospital Bed Capacity, under 100; D006801:Humans; D007175:Impulsive Behavior; D007223:Infant; D007297:Inpatients; D007629:Kentucky; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012047:Rehabilitation Centers; D012149:Restraint, Physical / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors