A Controlled Quality Improvement Trial to Reduce the Use of Physical Restraints in Older Hospitalized Adults

Objectives To implement and evaluate an evidence-informed multicomponent strategy to reduce physical restraint use in older adults admitted to acute care medical units. Design Stepped-wedge trial. Setting Four acute care medical units in Calgary, Alberta, over a 4-month time period. Participants Data were collected from individuals aged 65 and older present on the study units during monthly restraint audits. Intervention Development of opinion leaders among the nursing leadership, education and training of physicians and unit nurses, and implementation of least restraint rounds. Measurements The primary outcome was rate of restraint use as determined from walk-around audits. Secondary outcomes included number of physician orders for physical restraints on the electronic medical record and fall reports. Results Thirteen percent to 27% of individuals were being restrained on the medical units before the intervention, with the vast majority of restraints being bed rails. This decreased to 7% to 14% after the intervention. The intervention resulted in a statistically significant reduction in restraint use measured in the early mornings (P = .01), and this trend continued after adjusting for unit and month (P = .06). Similarly, the rate of restraint use trended down at all other measured time periods but was not statistically significant. A limited number of individuals had an order for physical restraint within their electronic medical record (3% before, 2% after the intervention). The median number of monthly fall reports did not change (three before, three after; P = .60). Conclusion A multicomponent team-focused quality improvement intervention has the potential to decrease the use of physical restraints in older hospitalized adults.