Physical Restraint Reduction in the Trauma Intensive Care Unit: A Quality Improvement Initiative.

Abstract

Background: Physical restraints are linked to adverse patient outcomes, yet there is limited research examining effective strategies to reduce restraint use in trauma intensive care units.

Objective: This study aims to assess the impact of a multicomponent physical restraint reduction initiative on restraint use in trauma intensive care unit patients.

Methods: This quality improvement project used a survey and a pre- and post-intervention methodology. The study compared restraint data from matching four-month periods in 2023 and 2024 in an 885-bed level I trauma center intensive care unit in the Southeastern United States. The study inclusion criteria were adult trauma patients (age > 18) and intensive care unit registered nurses. The exclusion criteria included pediatric patients and those requiring physical restraints for violent behavior. The project was conducted in five phases: (1) baseline staff survey of restraint use perceptions, (2) targeted education on restraint reduction strategies, (3) comparison of pre- and post-intervention restraint hours, (4) follow-up staff perception survey, and (5) analysis of restraint episodes and duration to measure impact.

Results: In total, 40 clinical staff completed the surveys, and 422 patient physical restraint episodes totaling 6,606 physical restraint hours were reviewed. Compared to the same four-month period in 2023, restraint hours decreased by 13.9%, and restraint episodes decreased by 16.6% in 2024.

Conclusion: This study of a multicomponent physical restraint reduction initiative reduced physical restraint use by identifying common barriers to proper application and educating staff on alternative measures. The intervention resulted in fewer restraint episodes and decreased total restraint hours.