Salamma Sabu John
Female Psychiatry Unit
RH, Dubai
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Introduction
Definition
Objectives
Background
Literature Review
Strategies
Implementation
Outcome
Challenges /Lessons Learnt
Summary
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Physical Restrain is a manual
method that restricts freedom of
movement or normal access to
one’s body, contingent on
maladaptive behaviours that is
used when there is an imminent
risk of harm to the individual or
others
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To improve the practice of physical restrain
use in patient care
To reduce the length of stay for patients on
physical restrain
To improve safety for both patients and the
staff in a psychiatric unit.
Ms.Salamma Sabu John
 Ms.Florence Okonkow
 Ms.Joyce Saldanha
 Ms.Sini Nair
 Ms.Felma Ison
 Ms.Libeth Dipasupil
 Ms.Jhoanna Lapez
 Ms.Jasmin Suico
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NS-Ms.Sumini John
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Physical restrain had been used as 1st resort
Many patients were on physical restrain for a
longer period of time.
All admitted psychiatric patients had restrain
as a PRN order!!
Alternative interventions not implemented
before placing the patient on restrain.
Improper restrain devices used.
No standard policy & monitoring system for
physical restrain.
Non
compliance to existing policy
No physician order
No documentation regarding the reason for using
restrain
Improper monitoring
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A study conducted in Ontario, use of
restraints in health care organization is
restricted using least restraint, to encourage
the use of alternative methods of physical
restraint whenever possible.
Physical restraint should be used as a last
resort ,and only when the potential benefits
are greater than the potential harm
secondary to the enforced immobility of
restraint.
College of nurses of Ontario (2004) practice standard: restraints. Toronto, Ontario, Canada
To minimize the risk of injury:
 Ensure
the correct application of the
restraint
device
according
to
the
manufactures recommendations.
 Maintain appropriate observation during
the time that a person is restrained.
 Provide staff orientation and in-service
education on the correct use of physical
restraint devices.
 Once
initiated, the need for physical
restrain should be reviewed regularly
THE JOANNA BRIGGS INSTITUTE
, Volume 6, Issue 3, page 5, 2002
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Staff orientation & education
Encourage the nursing staff to use other
alternatives to avoid physical restrain use.
To introduce standard restrain device
To revise the current policy according to the
best practice.
To reinforce the staff to comply the existing
policy.
To monitor implementations – development
of KPI
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Conducted Education session-consequence
related to physical restrain & importance of
proper monitoring & attending needs of the
patient while on physical restrain.
Introduced non-physical restrain strategies
like de-escalation technique, chemical
restrain etc.
Introduced standard physical restrain device.
Revised physical restrain policy.
Monitored compliance to policy by chart
audit.
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Policy revised according to evidence based
practice.
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Physical restrain used as last resort
No PRN orders
One-one observation for all patients on physical restrain.
Each psychiatric episode of restraint valid for 4 hrs only
Improved staff knowledge /awareness about the
consequence/risk related to physical restraint.
New KPI implemented to measure the length of stay
in physical restrain by each patient,(2011).
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Length of time - Approval for the revised
policy (multi-disciplinary policy)
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Resistance to change from the physicians
Lack of Compliance to policy from the nurses
Constant reinforcement & monitoring
New KPI monitoring for Physical Restrain
To
avoid the use of Physical Restrain
Conduct timely assessment & reassessmentimprove the clients overall status.
Implement other intervention like de-escalation
technique.
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If Physical Restrain used
Follow organization policy
One-one observation
Attend the needs of the patients
Reduce the length of stay in restrain
Physical Restrain must be used as a last
resort when there is an ‘imminent risk’ AND
all other interventions have been applied &
have proven failed