Clinical Audit on Physical

Restraint

From AUG -2020 to JAN -2021

6 months
 INTRODUCTION
Restraint is restricting an individual's freedom of
movement, physical activity, or normal access to
the body.

Restraint of patients in hospitals may be chemical and physical.

Physical restraint: Refers to devices and practices that restrict a

patient’s movement.

Chemical restraint: The use of a sedating psychotropic drug to

manage or control behaviour.
 TEAM MEMBERS

• Dr Sateesh
• ICU nursing incharge
• Medical social worker
 PROBLEM STATEMENT

A study to assess the compliance to restraint

orders and consent based on patients condition
and the same is properly conveyed to the
patient’s family members
 NEED FOR THE RESTRAINT

• To prevent interference /obstruction to medical

treatments (such as self extubation and intubation).
• To protect medical devices (such as intravenous lines, in
- dwelling urinary catheters, and feeding tubes).
• To prevent patient fall and injury of any kind.
• To control disruptive behaviour (such as agitation,
wandering, and combativeness).
• To preclude the possibility of harming self, staff and
other patients
 
 Need for the study

• Patient’s main family member is unhappy

because of uninformed restraining of their
patient despite signing for restraint consent by
the other family member
 OBJECTIVES FOR THE STUDY

• Patient’s family are to be properly informed

the need for restraints.
• Simple signing the consent form is not
sufficient.
• The activity of restraining is to be discussed in
detailed during family counselling within next
24 hours.
 AIM
• To improve the Documentation on Restraint
process
• Family meeting under video recording
• More detailed explanation to the family about
restraints
 AUDIT CYCLE
Assess
the need
for
Restraint.
Daily assessment to
remove the restraint at Doctor order
the earliest.

Obtain consent from family

Validity of And properly conveyed to
consent 24
hours Family counselling the family
with video recording

Iimitation of
Releasing of physical
restraint 2nd Restraint.
hourly

Hourly
monitoring
 DATA COLLECTION PLAN

• A team was formed comprising the ICU head, ICU

sister in-charge and medical social worker
• Sessions were conducted to ascertain the causes
and various reasons.
• Direct observation of patients, nurse interview,
and medical record review conducted by trained
observers.
• Daily monitoring by Doctor and the incharge nurse.
 Period of study
• August 2020 to January 2021
 Improvement phase
• Monitoring process.
• Regular training and checking.
• Patient and family participation
• Family meeting as and when required.
• To improve process of Documentation by
Doctors under video counselling.
• Introduction of a new checklist for compliance
supervised by the ICU Doctor on daily basis
Total Number of patients for clinical audit

• Aug 2
• Sept 2
• Oct 3
• Nov 5
• Dec 6
• Jan 18
• Total Sample size is 36 in 6 months
 Audit on Restraint orders and family meeting

• All have restraint consent - 36/36

• Family meeting not reinforced on restraints - 6/36
• Identified problem with family – 2/6
 Project Benefits

• Improving care and order compliance

• Improvement in documentation and process flow.
• Minimizing legal risk.
• Patient safety
• Improving Family Satisfaction by More detailed
explanation to the family about restraints