Planned change to implement a restraint reduction program

Physical restraints have been the standard of practice to manage certain ty pes of patient behavior, such as unstable mobility, wandering, agitation, a nd interference with medical treatment. However, this intervention is not w ithout serious negative consequences. Patients with neurological disorders or injuries are often at high risk for being restrained. The need to change to a more positive, patient-focused, restraint-free model was the goal of this project. A convenience sample of adult patients who were admitted to a neurological unit were studied. Outcome data that were assessed included ( 1) staff nurses' perception of restraints, (2) fall rate, (3) fall rate wit h injury, and (4) tube/line loss rate. Staff perceptions of restraints were assessed by administering the Perception of Restraints Use Questionnaire ( PRUQ) before and after implementation of the restraint-reduced environment. The results of the outcome data support the change to a more restraint-red uced environment, as indicated by fall rate, fall rate with injury, and tub e/line loss. Additionally, nurses' perceptions of restraints, as measured b y the PRUQ, indicated a trend toward less emphasis on the use of restraints to control specific unsafe or undesirable patient behaviors.