The impact of education on the use of physical restraints in the acute care setting.

BACKGROUND: Physical restraints have become an acceptable standard of practice for managing safety and behavior control in acute care settings. Although the primary intent for using physical restraints is for patient protection, there are many negative outcomes related to their use. Heightened awareness by recent Joint Commission on Accreditation of Healthcare Organizations and the Center for Medicare and Medicaid Services standards for restraint use has led health care administrators and nursing staff to explore methods of reducing or eliminating the use of restraints. An educational program was planned and implemented for nursing staff emphasizing the risks of physical restraints and the benefits of innovative optional measures including nonrestraint devices. The program was tested to determine whether increased awareness through education would reduce the use of restraints. METHOD: After current practice patterns and restraint utilization were established, a comprehensive educational program was provided to all nursing personnel. Twenty-three formal classroom inservice offerings were provided with follow-up reinforcement of self-study modules. Education included nursing assessment strategies and practical restraint optional interventions for managing patients exhibiting disruptive behaviors. FINDINGS: After the educational program, the overall use of physical restraints decreased as well as the length of time patients were restrained. CONCLUSION: Results of this study reinforce the need to increase staff awareness and knowledge of nonrestraint interventions to manage disruptive behaviors in the acute care setting.

Documentation of characteristics of early hospital readmission of elderly patients. A challenge for inservice educators.

Researchers conducted a retrospective review of 127 hospital records over a 3-month period to examine factors related to early hospital readmissions of patients age 65 and over. The leading diagnoses resulting in early readmissions were related to heart and circulatory problems, with a mean of 12.5 days between discharge and readmission. Gaps in documentation and the need for including qualitative data are discussed. Staff development educators are central to implementing strategies to correct these documentation deficiencies.