Staffing and pattern of mechanical restraint use across a multiple hospital system

Background: In an effort to enhance patient safety in acute care settings, governmental and regulatory agencies have established initiatives aimed at limiting the use of mechanical restraints. Concurrently, hospital staffing levels are undergoing changes raising concerns about the impact these chang es may have on restraint use. No studies to date have described the impact these two initiatives have had on restraint use in acute care hospitals. Objectives: To determine across a multiple hospital system: (a) the rates, frequencies, duration, and timing of restraint use, and (b) the relationshi p between restraint use and staffing. Methods: This was a secondary analysis of prospective, observational data f rom a large outcomes database for 10 acute care hospitals. Monthly data wer e obtained from 94 patient care units for periods ranging from 1-12 months for a total of 566 cumulative months during 1999. Results: The system restraint application duration rate (total restraint ho urs/total possible hours) was 2.8% (hospital ranges: 0.3-4.4%). More restra ints were applied on night shifts (48.8%; n = 5,296) than on day (33.5%; n = 3,634) or evening shifts (17.7%; n = 1,926) (p < .0001) and most applied at midnight (31.7%; n = 3,441) followed by 0600-0900 (33.3%; n = 3,614). Th ere was a weak positive relationship between staffing and restraint use (r = 0.276, p =.0001) at the system level and units with higher staffing level s also had higher baseline restraint use (p < .0001). Conclusions: Restraint frequency, duration, and timing may have been altere d by recent initiatives, and there is beginning evidence that differences e xist between community, rural, and tertiary hospitals. While there is a wea k positive relationship between higher staffing and restraint use at the sy stem and unit level, further exploration of the influence of other factors, specifically patient acuity, are in order. The finding of unit variability and consistent restraint application times provides a starting point for f urther quality initiatives or research interventions aimed at restraint red uction.