Restraint reduction in acute hospital care by preventive patient involvement.



Although the reduction of restraints is recommended in all areas of health care, there is little evidence specific for the hospital setting. Previous reduction initiatives have mainly focused on staff education and multicomponent/complex interventions. However, the effectiveness of these interventions was very heterogeneous (often little to no effect). In the psychiatric and long-term care settings, approaches that actively involved patients in decision-making and prevention of restraints are recommended and, at least in psychiatric care, proven to be effective. This type of approach has never been studied in the hospital setting. Therefore, the aim of this project is to develop an approach for a proactive and structured patient involvement in the prevention of restraint in hospital settings and to investigate its feasibility and acceptance.

Course of action

The approach for the proactive and structured patient involvement for the prevention of restraint in the hospital will be designed by the project team considering the internal guidelines on restraint of the pilot hospital as well as (inter)national literature and will be differentiated together with the nursing expert of the pilot ward, defined nurses of the pilot ward, members of the patient council of the hospital and (inter)national restraint experts. It is foreseen that the findings from the nursing admission interview will be reflected in a structured manner regarding the risk of restraint use and that it will be discussed with the patient (> 65 years) and/or their legal representative. Measures to prevent restraint are then defined together with the patient. These preventive measures usually target the triggers that can lead to restraint use. The risk assessment and the prevention measures are recorded in the patient documentation. It is assumed that raising awareness of the risk that the patient could be restrained during hospital stay and the immediate and individualised availability of preventive measures will improve restraint prevention and thereby reduce restraint use. The intervention will be piloted on one ward for one month and then evaluated for feasibility and acceptance.

This project contributes to the following SDGs

  • 3: Good health and well-being