Prevalence and variation of physical restraint use in acute care settings in the US.
OBJECTIVE
To describe physical restraint (PR) rates and contexts in U.S. hospitals.


METHODS
This 2003-2005 descriptive study was done to measure PR prevalence and contexts (census, gender, age, ventilation status, PR type, and rationale) at 40 randomly selected acute care hospitals in six U.S. metropolitan areas. All units except psychiatric, emergency, operative, obstetric, and long-term care were included.


METHODS
On 18 randomly selected days between 0500 and 0700 (5:00 am and 7:00 am), data collectors determined PR use and contexts via observation and nurse report.


RESULTS
PR prevalence was 50 per 1,000 patient days (based on 155,412 patient days). Preventing disruption of therapy was the chief reason cited. PR rates varied by unit type, with adult ICU rates the highest obtained. Intra- and interinstitutional variation was as high as 10-fold. Ventilator use was strongly associated with PR use. Elderly patients were over-represented among the physically restrained on some units (e.g., medical) but on many unit types (including most ICUs) their PR use was consistent with those of other adults.


CONCLUSIONS
Wide rate variation indicates the need to examine administratively mediated variables and the promotion of unit-based improvement efforts. Anesthetic and sedation practices have contributed to high variation in ICU PR rates. Determining the types of units to target to achieve improvements in care of older adults requires study of PR sequelae rate by unit type.
Minnick
Ann F
AF
School of Nursing, Vanderbilt University, Nashville, TN 37240, USA. Ann.Minnick@vanderbilt.edu
Mion
Lorraine C
LC
Johnson
Mary E
ME
Catrambone
Cathy
C
Leipzig
Rosanne
R
D000208:Acute Disease / Q000451:nursing*; D001291:Attitude of Health Personnel; D019985:Benchmarking; D005544:Forecasting; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009042:Motivation; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D015995:Prevalence; D012149:Restraint, Physical / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration; D014481:United States