Prevalence and Variation of Physical Restraint Use in Acute Care Settings in the US

Authors

  • Ann F. Minnick,

    1. Ann F. Minnick, RN, PhD, FAAN, Gamma Phi, Chenault Professor of Nursing, School of Nursing, Vanderbilt University, Nashville, TN; Lorraine C. Mion, RN, PhD, FAAN, Alpha Mu, Director, Nursing Research, MetroHealth Care Medical Center, Cleveland, OH; Mary E. Johnson, RN, PhD, Associate Professor, College of Nursing, Rush University, Chicago, IL; Cathy Catrambone, RN, DNSc, Instructor, College of Nursing, Rush University, Chicago, IL; Rosanne Leipzig, MD, Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY. The project was supported by Grant 1R01AG19715-01 from the National Institute on Aging. Contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute on Aging, NIH. Correspondence to Dr. Minnick, Vanderbilt University, Godchaux Hall, Room 424, 21st Avenue South, Nashville, TN 37240. E-mail: Ann.Minnick@vanderbilt.edu
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  • Lorraine C. Mion,

    1. Ann F. Minnick, RN, PhD, FAAN, Gamma Phi, Chenault Professor of Nursing, School of Nursing, Vanderbilt University, Nashville, TN; Lorraine C. Mion, RN, PhD, FAAN, Alpha Mu, Director, Nursing Research, MetroHealth Care Medical Center, Cleveland, OH; Mary E. Johnson, RN, PhD, Associate Professor, College of Nursing, Rush University, Chicago, IL; Cathy Catrambone, RN, DNSc, Instructor, College of Nursing, Rush University, Chicago, IL; Rosanne Leipzig, MD, Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY. The project was supported by Grant 1R01AG19715-01 from the National Institute on Aging. Contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute on Aging, NIH. Correspondence to Dr. Minnick, Vanderbilt University, Godchaux Hall, Room 424, 21st Avenue South, Nashville, TN 37240. E-mail: Ann.Minnick@vanderbilt.edu
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  • Mary E. Johnson,

    1. Ann F. Minnick, RN, PhD, FAAN, Gamma Phi, Chenault Professor of Nursing, School of Nursing, Vanderbilt University, Nashville, TN; Lorraine C. Mion, RN, PhD, FAAN, Alpha Mu, Director, Nursing Research, MetroHealth Care Medical Center, Cleveland, OH; Mary E. Johnson, RN, PhD, Associate Professor, College of Nursing, Rush University, Chicago, IL; Cathy Catrambone, RN, DNSc, Instructor, College of Nursing, Rush University, Chicago, IL; Rosanne Leipzig, MD, Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY. The project was supported by Grant 1R01AG19715-01 from the National Institute on Aging. Contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute on Aging, NIH. Correspondence to Dr. Minnick, Vanderbilt University, Godchaux Hall, Room 424, 21st Avenue South, Nashville, TN 37240. E-mail: Ann.Minnick@vanderbilt.edu
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  • Cathy Catrambone,

    1. Ann F. Minnick, RN, PhD, FAAN, Gamma Phi, Chenault Professor of Nursing, School of Nursing, Vanderbilt University, Nashville, TN; Lorraine C. Mion, RN, PhD, FAAN, Alpha Mu, Director, Nursing Research, MetroHealth Care Medical Center, Cleveland, OH; Mary E. Johnson, RN, PhD, Associate Professor, College of Nursing, Rush University, Chicago, IL; Cathy Catrambone, RN, DNSc, Instructor, College of Nursing, Rush University, Chicago, IL; Rosanne Leipzig, MD, Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY. The project was supported by Grant 1R01AG19715-01 from the National Institute on Aging. Contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute on Aging, NIH. Correspondence to Dr. Minnick, Vanderbilt University, Godchaux Hall, Room 424, 21st Avenue South, Nashville, TN 37240. E-mail: Ann.Minnick@vanderbilt.edu
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  • Rosanne Leipzig

    1. Ann F. Minnick, RN, PhD, FAAN, Gamma Phi, Chenault Professor of Nursing, School of Nursing, Vanderbilt University, Nashville, TN; Lorraine C. Mion, RN, PhD, FAAN, Alpha Mu, Director, Nursing Research, MetroHealth Care Medical Center, Cleveland, OH; Mary E. Johnson, RN, PhD, Associate Professor, College of Nursing, Rush University, Chicago, IL; Cathy Catrambone, RN, DNSc, Instructor, College of Nursing, Rush University, Chicago, IL; Rosanne Leipzig, MD, Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY. The project was supported by Grant 1R01AG19715-01 from the National Institute on Aging. Contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute on Aging, NIH. Correspondence to Dr. Minnick, Vanderbilt University, Godchaux Hall, Room 424, 21st Avenue South, Nashville, TN 37240. E-mail: Ann.Minnick@vanderbilt.edu
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Abstract

Purpose: To describe physical restraint (PR) rates and contexts in U.S. hospitals.

Design: This 2003–2005 descriptive study was done to measure PR prevalence and contexts (census, gender, age, ventilation status, PR type, and rationale) at 40 randomly selected acute care hospitals in six U.S. metropolitan areas. All units except psychiatric, emergency, operative, obstetric, and long-term care were included.

Methods: On 18 randomly selected days between 0500 and 0700 (5:00 am and 7:00 am), data collectors determined PR use and contexts via observation and nurse report.

Findings: PR prevalence was 50 per 1,000 patient days (based on 155,412 patient days). Preventing disruption of therapy was the chief reason cited. PR rates varied by unit type, with adult ICU rates the highest obtained. Intra- and interinstitutional variation was as high as 10-fold. Ventilator use was strongly associated with PR use. Elderly patients were over-represented among the physically restrained on some units (e.g., medical) but on many unit types (including most ICUs) their PR use was consistent with those of other adults.

Conclusions: Wide rate variation indicates the need to examine administratively mediated variables and the promotion of unit-based improvement efforts. Anesthetic and sedation practices have contributed to high variation in ICU PR rates. Determining the types of units to target to achieve improvements in care of older adults requires study of PR sequelae rate by unit type.

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