The Effect of a Care Bundle on Physical Restraint Rate, Duration and Complications in ICU Patients.

OBJECTIVE

This study aimed to evaluate the effect of the Physical Restraint Reduction Care Bundle (PRRCB) on the rate, duration and complications of physical restraint use in the intensive care unit of a university hospital in Turkey.

METHODS

The research was a quasi-experimental preobservational and postobservational study. The i-PARIHS framework was used as a comprehensive model. A systematic review of the literature and modified Delphi methods were used to develop guidelines. After training, the unit nurses used the PRRCB including the guideline, care map, training, documentation form and decision support tools.

RESULTS

Physical restraint was performed on 444 (48.1%) patients days before and 346 (39.7%) after the intervention, and this difference was statistically significant. The physical restraint rate in the postintervention group is 0.71 times less than before (OR = 0.71, 95% CI: 0.59-0.85; OR = 0.86, 95% CI: 0.76-0.96). The duration of physical restraint was 8.85 ± 8.21 days before and 7.27 ± 5.17 after the intervention, but there was no significant difference in this decrease (t = 1.048, p = 0.297, MD = -0.91, 95% CI: -8.50-6.67). There was a significant decrease in all complications, including colour, temperature, oedema, pitting and skin/tissue integrity of the restrained extremity (p = 0.005; p = 0.009; p < 0.001; p = 0.027; p < 0.001).

CONCLUSIONS

The i-PARIHS-guided care bundle, PRRB, successfully reduced the rate and complications of physical restraint but not the mean duration of patient restraint days.