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Clinical and organizational factors related to the reduction of mechanical restraint application in an acute ward: an 8-year retrospective analysis.

Lorenzo RD, Miani F, Formicola V, Ferri P - Clin Pract Epidemiol Ment Health (2014)

Bottom Line: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts.Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression).The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach.

View Article: PubMed Central - PubMed

Affiliation: Psychiatrist of Mental Health Department, SPDC-Modena Centro, NOCSAE, via Giardini 1355, 41126 Baggiovara(MO), Italy.

ABSTRACT

Background: The purpose of this study was to describe the frequency of mechanical restraint use in an acute psychiatric ward and to analyze which variables may have significantly influenced the use of this procedure.

Methods: This retrospective study was conducted in the Servizio Psichiatrico di Diagnosi e Cura (SPDC) of Modena Centro. The following variables of our sample, represented by all restrained patients admitted from 1-1-2005 to 31-12-2012, were analyzed: age, gender, nationality, psychiatric diagnoses, organic comorbidity, state and duration of admission, motivation and duration of restraints, nursing shift and hospitalization day of restraint, number of patients admitted at the time of restraint and institutional changes during the observation period. The above variables were statistically compared with those of all other non-restrained patients admitted to our ward in the same period.

Results: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts. Neurocognitive disorders, organic comorbidity, compulsory state and long duration of admission were statistically significantly related to the increase of restraint use (p<.001, multivariate logistic regression). Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression).

Conclusion: The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach.

No MeSH data available.


Related in: MedlinePlus

Number of restraints in the 8-year period of observation.
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Figure 2: Number of restraints in the 8-year period of observation.

Mentions: The number of restraints per year progressively declined during the 8-year period (Fig. 2). The reduction of restraints was statistically significantly related to all the institutional changes that occurred in the observation period: the change of medical staff in 2008 (Pearson chi2 = 157.0559, p<.001), the increase in nurses per shift and the ward relocation in 2009 (Pearson chi2 = 112.0902, p<.001) and the implementation of more restricted guidelines for restraint application in 2011 (Pearson chi2 = 157.0559, p<.001).


Clinical and organizational factors related to the reduction of mechanical restraint application in an acute ward: an 8-year retrospective analysis.

Lorenzo RD, Miani F, Formicola V, Ferri P - Clin Pract Epidemiol Ment Health (2014)

Number of restraints in the 8-year period of observation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4196251&req=5

Figure 2: Number of restraints in the 8-year period of observation.
Mentions: The number of restraints per year progressively declined during the 8-year period (Fig. 2). The reduction of restraints was statistically significantly related to all the institutional changes that occurred in the observation period: the change of medical staff in 2008 (Pearson chi2 = 157.0559, p<.001), the increase in nurses per shift and the ward relocation in 2009 (Pearson chi2 = 112.0902, p<.001) and the implementation of more restricted guidelines for restraint application in 2011 (Pearson chi2 = 157.0559, p<.001).

Bottom Line: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts.Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression).The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach.

View Article: PubMed Central - PubMed

Affiliation: Psychiatrist of Mental Health Department, SPDC-Modena Centro, NOCSAE, via Giardini 1355, 41126 Baggiovara(MO), Italy.

ABSTRACT

Background: The purpose of this study was to describe the frequency of mechanical restraint use in an acute psychiatric ward and to analyze which variables may have significantly influenced the use of this procedure.

Methods: This retrospective study was conducted in the Servizio Psichiatrico di Diagnosi e Cura (SPDC) of Modena Centro. The following variables of our sample, represented by all restrained patients admitted from 1-1-2005 to 31-12-2012, were analyzed: age, gender, nationality, psychiatric diagnoses, organic comorbidity, state and duration of admission, motivation and duration of restraints, nursing shift and hospitalization day of restraint, number of patients admitted at the time of restraint and institutional changes during the observation period. The above variables were statistically compared with those of all other non-restrained patients admitted to our ward in the same period.

Results: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts. Neurocognitive disorders, organic comorbidity, compulsory state and long duration of admission were statistically significantly related to the increase of restraint use (p<.001, multivariate logistic regression). Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression).

Conclusion: The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach.

No MeSH data available.


Related in: MedlinePlus