[Predictors of Adverse Events Following Physical Restraint in Internal Medicine Ward Patients: An Exploratory Study].

Abstract

Background: Physical restraint, commonly used in medical wards to prevent self-extubation and agitation, sometimes fails to achieve one or both of these objectives. Thus, the factors contributing to the occurrence of self-extubation and agitation under restraint require further exploration.

Purpose: This study was developed to identify the predictors of two types of adverse events (unplanned device removal and agitation) among hospitalized patients under physical restraint in medical wards.

Methods: This retrospective study analyzed the medical records of 100 patients aged ≥ 20 years who had been physically restrained in a regional teaching hospital in Taipei between January 2022 and February 2023. Poisson regression was used to examine predictors across the four domains of demographic, emotional, social, and medical factors.

Results: The significant predictors of extubation during physical restraint identified in the analysis included having a foreign caregiver (B = 0.81, p = .01), emotional instability (B = 1.36, p = .02), a history of extubations during restraint (B = 0.61, p = .02), and a history of agitation episodes before restraint (B = 1.13, p = .04). Predictors of agitation during restraint included use of non-steroidal anti-inflammatory drugs (B = 1.27, p < .01), medication use during agitation (B = 0.75, p < .01), restraint for treatment purposes (B = 0.63, p = .04), and a history of extubations (B = 0.55, p = .02) or agitation (B = 1.44, p = .02).

Conclusions: Based on these findings, recommendations for reducing adverse events following physical restraint include prioritizing family caregivers, receiving routine emotional assessments, monitoring medications, and enhancing communication and non-pharmacological strategies prior to restraint.