Decline in Physical Restraint Use Following Implementation of Institutional Guidelines

J Nurs Adm. 2021 Jun 1;51(6):318-323. doi: 10.1097/NNA.0000000000001020.


Objective: To investigate the strategies implemented at our institution to reduce medical restraint use.

Background: Restraints have been utilized to prevent agitation, self-extubations, and falls, although they are often associated with negative repercussions for nurses and patients.

Methods: The restraint data at our institution were compared with the National Database of Nursing Quality Indicators (NDNQI) benchmark. We also described the measures taken to improve restraint documentation.

Results: The number of patients in medical restraints, medical restraint hours, medical restraints/patient-days, and deaths in restraints at our institution all significantly decreased (P < 0.00001). There were 27 self-extubations of restrained patients compared with 11 self-extubations of nonrestrained patients. The percentage of inpatients with restraints in critical care and step-down areas declined and remained below the NDNQI benchmark.

Conclusions: This study reports the processes implemented to reduce restraint use through enhanced communication and increased documentation. Further exploration into factors that may attain a restraint-free environment is warranted.

MeSH terms

  • Accidental Falls / prevention & control
  • Documentation
  • Guidelines as Topic / standards*
  • Humans
  • Quality Indicators, Health Care
  • Restraint, Physical / instrumentation
  • Restraint, Physical / methods*