PubMed search: restraint AND prevalence AND (hospitals OR wards OR units) AND psychiatric
restraint AND prevalence AND (hospitals OR wards OR units) AND (geriatric OR elderly) AND acute care
Riv Psichiatr. 2013 Jan-Feb;48(1):10-22. doi: 10.1708/1228.13611.
Prevalence and risk factors for the use of restraint in psychiatry: a systematic review.
Beghi M, et al.
Click here to run a PubMed search on use of companions (or playthings) in patients with dementia. There appears to be minimal research on this topic at this point.
Systematic reviews
Mechanical restraint-which interventions prevent episodes of mechanical restraint?-a systematic review. Bak J, Brandt-Christensen M, Sestoft DM, Zoffmann V. Perspect Psychiatr Care. 2011 Apr 19.
Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: a systematic review. Kynoch K, Wu CJ, Chang AM. Worldviews Evid Based Nurs. 2011 Jun;8(2):76-86.
Special care units for dementia individuals with behavioural problems. Lai CK, Yeung JH, Mok V, Chi I. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006470.
Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far a review of the literature. Scanlan JN. Int J Soc Psychiatry. 2010 Jul;56(4):412-23.
Changing the practice of physical restraint use in acute care. Park M, Tang JH.
J Gerontol Nurs. 2007 Feb;33(2):9-16
A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short-term management of violence in adult psychiatric inpatient settings and emergency departments. Nelstrop L, et al. Worldviews Evid Based Nurs. 2006;3(1):8-18.
Other recent studies on reducing restraint use:
The effect of staff training on agitation and use of restraint in nursing home residents with dementia: a single-blind, randomized controlled trial. Testad I, Ballard C, Brønnick K, Aarsland D. J Clin Psychiatry. 2010 Jan;71(1):80-6.
A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents. Huizing AR, Hamers JP, Gulpers MJ, Berger MP. J Am Geriatr Soc. 2009 Jul;57(7):1139-48.
Bottom line: There is some limited evidence that use of risk assessment tools can predict violent behavior by patients and can be associated with reduction in aggressive incidents.
A systematic review in JBI+ COnNECT (JBI Library of Systematic Reviews. 2009;7(6):175-223) identified one retrospective study (Kling, 2006) of a tool to assess inpatients for risk of violent behavior. In PubMed this reference led to other studies, including an RCT (Abderhalden, 2008) and a pilot study (Fluttert 2011)
Kling, R., et al., Use of a violence risk assessment tool in an acute care hospital: effectiveness in identifying violent patients. AAOHN Journal, 2006. 54(11): p. 481-7. (Available in print at Health Sciences Center Library.)
Reviewed charts at 1 acute care hospital for 117 violent patients and 161 randomly selected, nonviolent patients admitted during the same period. Compared findings of a risk assessment tool in these populations. Tool had moderate senstivity (71%) and high specificity (94%). Limitation – only 35% of the non-violent patients and 75% of the violent patients were evaluated using the tool.
Abderhalden C, et al. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial. Br J Psychiatry. 2008 Jul;193(1):44-50.
Cluster RCT randomized 14 psychiatric units to use of Swiss version of the Brøset Violence Checklist (BVC–CH) or usual care for patients admitted to these units. RESULTS: Adjusted RR indicate 41% reduction in severe aggressive incidents and a 27% decrease in use of coercive measures. There was no decrease in severity of aggressive incidents.
Fluttert FA, et al. The development of the Forensic Early Warning Signs of Aggression Inventory: preliminary findings toward a better management of inpatient aggression. Arch Psychiatr Nurs. 2011 Apr;25(2):129-37.
Describes development of a new risk assessment tool.
PubMed search: “Inpatients/psychology”[mesh] AND “Violence/prevention and control”[mesh] AND assess*
Reviewed 4/18/14 AA
See these selected articles identified in PubMed
Reviewed and updated 4/11/2014 ldt
ait Bottom line: No national benchmark for restraint use in rehabilitation facilities was identified in the NDNQI, but one study published data on prevalence (restraint use per 100 patient days) of physical restraints prior to implementing a reduction program in this setting.
Minnick AF, et al. Prevalence and variation of physical restraint use in acute care settings in the US. J Nurs Scholarsh. 2007;39(1):30-37.
Prevalence of physical restraint on 18 randomly selected days found a prevalence of 50 uses per 1,000 patient days.
Amato S, et al. Physical restraint reduction in the acute rehabilitation setting: a quality improvement study. Rehabil Nurs. 2006;31(6):235-241.
This prospective study measured restraint use before and after a multi-pronged approach to decreasing the use of restraints in a stroke rehabilitation unit and a brain injury rehabilitation unit. Restraint use before the intervention started:
Stroke Rehab Unit: 216.6 hours per 100 patient days
Brain Injury Rehab Unit: 1054.3 hours per 100 patient days
Kwok T, et al. Does access to bed-chair pressure sensors reduce physical restraint use in the rehabilitative care setting? J Clin Nurs. 2006 May;15(5):581-7.
Reports on use of physical restraints by providing the percentage of patients who were physically restrained for some portion of their hospital stay.
Gallinagh R, et al. The use of physical restraints as a safety measure in the care of older people in four rehabilitation wards: findings from an exploratory study. Int J Nurs Stud. 2002;39(2):147-156.
Uses percentages of patients and not restraint use/1000 patient days.
Reviewed 4/10/2014
Bottom line: In ICU units many intubated patients who remove their own tubes do so while some type of physical restraint is in use.
A search of PubMed, CINAHL and EMBASE retrieved only studies of patients in intensive care. No direct published evidence addresses efficacy of restraints at reducing self-extubations in patients outside of ICU units. The following systematic review addresses association between use of restraints and self-extubation in patients on ICU units.
da Silva PS, Fonseca MC. Unplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations. Anesth Analg. 2012;114(5):1003-1014.
Seventeen of the fifty studies that were included in this systematic review examined the incidence of unplanned extubation in physically restrained patients. The percentage of restrained patients under physical restraint at the time of unplanned extubations ranged from 25%” to 87%. Only one study identified the use of physical restraints as a risk factor for unplanned extubations on multivariate analysis (OR 3.1, 95% CI 1.71–5.7). The article concluded that use of physical restraints remains controversial.
Reviewed and updated 4/10/2014 ldt
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