Jérôme E Dauvergne, Kim Ferey, Véronique Croizard, Morgan Chauvin, Nolwenn Mainguy, Noeline Mathelier, Anaëlle Jehanno, Nadège Maugars, Gaëtan Badre, Françoise Maze, Marie Chartier, Servane Vastral, Graziella Epain, Lucie Baudiniere, Mathilde Ronceray, Mathias Lebidan, Delphine Flattres, Xavier Ambrosi
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Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool.</p><p><strong>Aims: </strong>Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use.</p><p><strong>Study design: </strong>A large observational, multicentre study with a repeated one-day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect.</p><p><strong>Results: </strong>During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%-31.4%) and 25% (95% CI: 21.5%-29.1%) respectively (χ<sup>2</sup> = 1.35; p = .24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p = .14). The patient-to-nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p < .001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5-10.2]).</p><p><strong>Conclusion: </strong>The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial.</p><p><strong>Relevance to clinical practice: </strong>The decision to physically restrain a patient could be protocolised and managed by critical care nurses. 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引用次数: 0
摘要
背景：重症监护病房经常使用物理约束，以防止病人在危及生命的情况下拔出留置装置。在法国，对其使用情况的研究很少。因此，为了评估使用物理约束的必要性，我们设计并实施了一种决策支持工具。研究目的：除了描述物理约束使用的普遍性外，本研究还旨在评估护理决策支持工具的实施是否会对约束的使用产生影响，并确定与使用约束相关的因素：研究设计：这是一项大型多中心观察性研究，采用了一天重复点流行率设计。所有在重症监护病房住院的成年患者均符合研究条件。研究计划分为两个阶段：使用决策支持工具和员工培训之前（对照阶段）和之后（干预阶段）。研究采用多层次模型，以考虑中心效应：结果：在对照期纳入了 786 名患者，在干预期纳入了 510 名患者。身体约束的发生率分别为 28% (95% CI: 25.1%-31.4%) 和 25% (95% CI: 21.5%-29.1%) (χ2 = 1.35; p = .24)。在这两个时期，96%的病例由护士和/或护士助理实施约束，主要是手腕（89% vs. 83%，p = .14）。在干预期间，病人与护士的比例明显降低（1:3.0 ± 1 vs. 1:2.7 ± 0.7，p 结论：在干预期间，病人与护士的比例明显降低（1:3.0 ± 1 vs. 1:2.7 ± 0.7，p 结论）：法国使用物理约束的发生率低于预期。在我们的研究中，决策支持工具并未对物理约束的使用产生重大影响。因此，决策支持工具值得在随机对照试验中进行评估：对临床实践的意义：重症监护护士可以根据协议决定是否对患者实施物理约束。定期评估镇静程度可使镇静程度最深的患者免于使用物理约束。
Prevalence and risk factors of the use of physical restraint and impact of a decision support tool: A before-and-after study.
Background: Physical restraint is frequently used in intensive care units to prevent patients' life-threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool.
Aims: Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use.
Study design: A large observational, multicentre study with a repeated one-day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect.
Results: During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%-31.4%) and 25% (95% CI: 21.5%-29.1%) respectively (χ2 = 1.35; p = .24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p = .14). The patient-to-nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p < .001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5-10.2]).
Conclusion: The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial.
Relevance to clinical practice: The decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint.
期刊介绍：
Nursing in Critical Care is an international peer-reviewed journal covering any aspect of critical care nursing practice, research, education or management. Critical care nursing is defined as the whole spectrum of skills, knowledge and attitudes utilised by practitioners in any setting where adults or children, and their families, are experiencing acute and critical illness. Such settings encompass general and specialist hospitals, and the community. Nursing in Critical Care covers the diverse specialities of critical care nursing including surgery, medicine, cardiac, renal, neurosciences, haematology, obstetrics, accident and emergency, neonatal nursing and paediatrics.
Papers published in the journal normally fall into one of the following categories:
-research reports
-literature reviews
-developments in practice, education or management
-reflections on practice
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