Authors (including presenting author) :
Lo PY (1) Lee SW (2) Wong KK (3) Chow FY (3) Leung WC (3) Choi HL (4) Kan CY (4) Chan SP (3) Wong MS (4) Chan WC (1) Cheung KC (1) Tam YY (1) Ho SM (1)
Affiliation :
(1) Department of Medicine and Geriatrics, United Christian Hospital (2) Department of Nursing Services Division, United Christian Hospital (3) Department of Medicine, Tseung Kwan O Hospital (4) Department of Medicine, Yan Chai Hospital
Introduction :
Physical Restraint (PR) is commonly applied in clinical settings to prevent falls and manage behaviors related to delirium. Older adults are particularly vulnerable to adverse physical consequences of PR. This project aimed to promote early PR reduction and enhance nursing staff knowledge, attitude, and practice (KAP) by implementing a PR-reduction program named ‘FREE’ Bundle.
Objectives :
1. To evaluate the effectiveness of the PR-reduction program in improving nurses’ KAP in PR reduction.
2. To examine patient safety after PR reduction.
3. To examine nursing staff confidence, willingness, and awareness of PR reduction.
Methodology :
The ‘FREE’ Bundle targeted patients aged 65 or above and admitted with acute medical or geriatric problems in six acute medical wards of United Christian Hospital, Tseung Kwan O Hospital, and Yan Chai Hospital. Patients aged under 65 and admitted due to other health problems were excluded. It lasted for 4 weeks (20 May - 16 June 2024). It was developed in 4 phases:
1. Establishment of standardized materials
‘FREE’ bundle comprised:
F- Form Development for Monitoring Post-PR Reduction
R- Removal Decision Support Tool
E- Educational Campaigns
E- Evaluation Questionnaires Project materials were validated and standardized across hospitals.
2. Educational phase
3 sessions of 10-15-minute talk were conducted to introduce PR-reduction form and 4P communication tool (Pain, Position, Potty, and Possessions).
3. Implementation phase
Following the indications for PR reduction, alternative interventions were provided and patient conditions were monitored continuously.
4. Outcome Measurement and Data Collection
To evaluate the program effectiveness in improving nurses’ KAP in PR reduction, a modified Physical Restraint Questionnaire was conducted before and after the educational phase for pre-post study.
To assess patient safety in PR reduction, a PR-reduction form was used throughout the pilot period. Restraint period, types of restraint, and patient condition after PR reduction were collected.
Nursing staff feedback on PR reduction was evaluated through a survey on the last day of the project.
Result & Outcome :
PR reduction increased significantly from 5 trials pre-implementation to 24 trials post-implementation. Among the recruited 26 patients, 15 maintained a restraint-free status for at least 48 hours. Pre- and post- Physical Restraint Questionnaire showed improvements of nurses’ knowledge, attitude, and practice towards PR reduction, increasing 8.56%, 4.43%, and 9.39% respectively. The staff survey indicated high satisfaction with the FREE bundle program with 95.6% agreeing the program raised confidence, willingness, and awareness of PR reduction. The ‘FREE’ bundle effectively increased PR reduction trials and ensured close monitoring afterward, enhancing patient safety.
