Minimize Restraints in the NHS

The use of physical restraints in the Niagara Health System is an issue of growing concern due to the goal of patient-focused primary care.

Typically, physical restraints are implemented as a cost-effective method of ensuring staff and patient safety (Harmers, 2005; Lewis, Heitkemper, & Dirksen, 2010; Potter & Perry, 2010). Until recently, the use of restraints has been viewed in an ambivalent light; although they deter patient autonomy, ultimately, they were presumed to result in the “greater good” for all involved.

However, recent research has demonstrated that restraint usage is associated with detrimental effects for both the patient and the health care system (Bradas, Sandhu & Mion, 2011; Eaton, 2000; Evans, Wood, & Lambert, 2003; Sandu et al., 2010). The use of physical restraints has been linked to risk of physically and emotionally maladaptive processes.

Such processes include:
- Increased infection
- Increased falls
- Increased social isolation
- Increased functional/physical deterioration
- Increased injury/pressure ulcers
- Increased death.

Thus, restraint usage result in billions of dollars of expenditures in wages and supplies needed to manage these sequelae.

This petition proposes that the Niagara Health System investigates cost-effective alternatives to restraint usage (i.e., employing patient-watch personnel, placing mattresses on the floor near the bed of those who wander). Further, the process of restraint application should be minimized, with efficient screening to ensure all other options are exhausted prior to their usage.

The use of restraints minimizes patient autonomy, health, and emotional well-being. Taking measures to minimize their usage can promote cost-effective, patient-centered care.

References:
Bradas, C. M., Sandhu, S. K., & Mion, L. C. (2011). Physical Restraints and Side Rails in Acute and Critical Care Settings. Evidence-Based Geriatric Nursing Protocols for Best Practice, 229.
Eaton, S. C. (2000). Beyond ‘unloving care’: Linking human resource management and patient care quality in nursing homes. The International Journal of Human Resource Management, 11(3), 591-616.
Evans, D., Wood, J., & Lambert, L. (2003). Patient injury and physical restraint devices: A systematic review. Journal of Advanced Nursing, 41(3), 274-282. doi: 10.1046/j.1365-2685.2003.02501.x
Glezer, A., & Brendel, R. W. (2010). Beyond emergencies: the use of physical restraints in medical and psychiatric settings. Harvard Review of Psychiatry, 18(6), 353-358.
Hamers, F. J. (2005). Why do we use physical restraints in the elderly?. Zeitschrift für Gerontologie und Geriatrie, 38(1), 19-25.
Lewis, S. M., Heitkemper, M. M. & Dirksen, S. R. (2010). Medical-surgical nursing in Canada (2nd ed.). Toronto: Elsevier.
Potter, P. A., & Perry, A. G. (2010). Clinical nursing skills and techniques (7th ed.). Toronto: Evolve.
Sandhu, S. K., Mion, L. C., Khan, R. H., Ludwick, R., Claridge, J., Pile, J. C., ... & Dietrich, M. S. (2010). Likelihood of ordering physical restraints: influence of physician characteristics. Journal of the American Geriatrics Society, 58(7), 1272-1278.