Authors (including presenting author) :
Li HY(1), Ho LK(1), Li WT(1), Tsoi YK(1), Poon CL(1), Wong ST(2), Wong FY(3), Wong WY(1), Ng SC(1)
Affiliation :
(1)Department of Medicine, (2)Department of Physiotherapy (PT), (3)Department of Occupational Therapy (OT), Haven of Hope Hospital
Introduction :
Physical restraint is a contentious issue in healthcare settings. In Haven of Hope Hospital (HHH), the prevalence rate of physical restraint is high. Reasons for restraint use can mainly be categorized as fall prevention, management of aggressive behavior and securing medical devices. However, restraint use is associated with physical and psychological adverse events. To enhance patient care, a Physical Restraint Reduction Program (PRRP) has been implemented, adopting a multidisciplinary approach.
Objectives :
1. To reduce the prevalence of physical restraint use with multidisciplinary approach
2. To foster a culture of “trial without restraint”
Methodology :
A geriatrician led multidisciplinary workgroup was formed. An audit of physical restraint use was done and the service gaps were identified. Multiple measures were implemented.
1. Enhance patient’s mobility: updated the patient’s mobility level by physiotherapists in electronic bed-panel for effective communication among nurses and allied health professionals which facilitated the mobilization and toileting in ward.
2. Use of innovative equipment: occupational therapists had designed a trumpet mitten for securing medical devices. Anti-stripe jumper was adopted.
3. Educational and cultural development: four workshops were conducted to doctors, nurses and healthcare assistants to strengthen their knowledge on restraint use and promote the practice of “trial without restraint”. Multidisciplinary ward rounds were conducted to provide constructive suggestions for complicated cases.
4. Hospital-wide project: PRRP was put in risk registry of clinical service in 2022/23 and 2023/24.
Result & Outcome :
The PRRP piloted in two Geriatric and Rehabilitation wards at HHH since September 2023 and extended to the entire Department of Medicine (Total 15 wards) in July 2024. In 2024, the prevalence of physical restraint in HHH had significantly decreased to 14.9%, down from 26.2% in 2021, reflecting a reduction rate of 43.1%. The rate of trial without restraint increased from 40.7% (pre-program) to 85.5% (12/2024). Moreover, the fall rate remained similar since the implementation of PRRP.
Physical Restraint Reduction Program has significantly lowered the number of patients being physically restraint. It has also fostered a culture of restraint reduction. The similar fall rate before and after the program implies that reduction of restraint use is not associated with increased fall risk.
