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Department

Comprehensive Clinical Care

Position/Job Title

Clinical Nurse Specialist

Description

Background: Restraint use is closely monitored through National Database of Nursing Quality Indicators (NDNQI) metrics, system, and hospital-based committees. Currently, the acuity-adaptable intensive care units (ICU) at Henry Ford Jackson Hospital (HFJH) underperform the NDNQI mean use of restraints compared to similar units. At HFJH, the most ordered restraint is a non-violent, soft, bilateral wrist restraint on intensive care units for mechanically ventilated patients. Physical restraints in the ICU are ultimately used to minimize potentially harmful consequences of patients interfering with medical therapies. The ICU Liberation initiative, created by the Society of Critical Care Medicine, is shown to decrease restraint use and improve patient outcomes in the ICU. Despite the adherence to the ICU Liberation bundle, restraint use remains prevalent within the ICUs at HFJH. A restraint alternative, a mitt, does not restrict a patient’s ability to move his or her arms but does provide a barrier to grabbing medical equipment. By revising policy and updating the standard of care for ICU patients, one hospital was able to decrease restraint use and have zero non-violent restraints for over one year through mitts. Aims: This quality improvement project aims to decrease restraint use in the ICUs by implementing mitts as a restraint alternative. Methods: Led by a clinical nurse specialist (CNS), key stakeholder buy-in was essential. In collaboration with the nursing director, the restraint policy was critiqued and compared to the restraint definitions from The Joint Commission and Center for Medicare and Medicaid Services (CMS). A proposal was pitched to change the policy to mirror evidence-based practice and current definitions from accrediting bodies. After gaining support from the key stakeholders, the policy was amended to remove mitts under the restraint definition, and education was created and distributed to the bedside staff members. The CNS also coordinated with the representative for mitt products and initiated a trial for a new mitt product. Once education was completed, the CNSs, managers, and director of the intensive care units promoted a culture change to limit restraint use in the critically ill patient population and promote restraint alternatives. Results: The project was successfully implemented in June of 2024. After one month of implementation, hospital-wide restraint use decreased by 110 orders from a total 269 restraint orders in June, compared to 379 restraint orders in May. In the medical ICU, restraint orders decreased from 122 to 49 orders, a 40.2% reduction in restraint use. Conclusion: To date, there have been no adverse outcomes from promoting the restraint alternative, mitts, in the ICU. At the bedside, patients have demonstrated the ability to complete full range of motion while utilizing mitts. The mitts provide a barrier to the patient grabbing medical equipment without restricting movement of the fingers, hands, or arms. In addition, the mitts alternative offers a cost-savings by following manufacturer guidelines and having them laundered at the facility. Ongoing surveillance and monitoring will be continued to evaluate the success of the implementation.

Publication Date

4-15-2025

Keywords

Henry Ford Jackson Hospital Research Symposium, nursing, quality improvement

No Need to Restrain, Grab a Mitt and Refrain!!

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