title: Outcomes following physical restraint reduction programs in two acute care hospitals.
abstract: BACKGROUND
  Physical restraint rates can be reduced safely in long term care settings, but the strategies used to prevent wandering, falls, and patient aggression have not been tested for their effectiveness in preventing therapy disruption. A restraint reduction program (RRP) consisting of four core components (administrative, educational, consultative, and feedback) was implemented in 1998-1999 in 14 units at two acute care hospitals in geographically distant cities.
  
  
  METHODS
  The RRP was targeted at units with prevalence rates of > or = 4% for non-intensive care units (non-ICUs) and > or = 25% for ICUs, as well as two additional units. The RRP was implemented by an interdisciplinary team consisting of geriatricians and nurse specialists.
  
  
  RESULTS
  Of the 16,605 admissions to the RRP units, 2,772 cases received RRP consultations. Only six units (four of seven general units and two of six ICUs) demonstrated a relative reduction of > or = 20% in the physical restraint use rate. No increase in secondary outcomes of patient falls and therapy disruptions (patient-initiated discontinuation or dislodgment of therapeutic devices) occurred, injury rates were low, and no deaths occurred as a direct result of either a fall or therapy disruption event.
  
  
  CONCLUSIONS
  Given the minimal success in the ICU settings, further studies are needed to determine effective nonrestraint strategies for critical care patients. ICU clinicians need to be persuaded of the favorable risk-to-benefit ratio of alternatives to physical restraint before they will change their practice patterns.
  
  
  CONCLUSIONS
  Efforts to identify more effective interventions that match patient needs and to identify non-clinician factors that affect physical restraint use are needed.
authors.affiliation: Geriatric Nursing Program, Division of Nursing, Cleveland Clinic Foundation, Cleveland, USA. mionl@ccf.org
authors.forename: L C
authors.initials: LC
authors.lastname: Mion
authors.forename: J
authors.initials: J
authors.lastname: Fogel
authors.forename: S
authors.initials: S
authors.lastname: Sandhu
authors.forename: R M
authors.initials: RM
authors.lastname: Palmer
authors.forename: A F
authors.initials: AF
authors.lastname: Minnick
authors.forename: T
authors.initials: T
authors.lastname: Cranston
authors.forename: F
authors.initials: F
authors.lastname: Bethoux
authors.forename: C
authors.initials: C
authors.lastname: Merkel
authors.forename: C S
authors.initials: CS
authors.lastname: Berkman
authors.forename: R
authors.initials: R
authors.lastname: Leipzig
mesh_terms: D000046:Academic Medical Centers; D000058:Accidental Falls; D000328:Adult; D000368:Aged; D003693:Delirium / Q000175:diagnosis / Q000628:therapy; D020878:Device Removal; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007440:Intubation; D008297:Male; D010348:Patient Care Team; D010361:Patients / Q000145:classification; D012149:Restraint, Physical / Q000009:adverse effects / Q000706:statistics & numerical data*