Implementation of Physical Restraints in the Intensive Care Unit

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Table of Contents

Introduction
Description of Solution: Best Practice Staffing
The Implementation Plan and the Steps and Resources that will be Used
Evaluation Plan
Dissemination of Evidence
Conclusion
Reference List

Introduction

The aim of this paper is to present an implementation plan for the research problem that deals with the use of physical restraints in the intensive care unit. The steps and resources that will be used in the plan will also be presented. The paper also acknowledges the importance of evaluating any plan put in place to solve a problem.

Towards this end, the paper will present the evaluation plan of the proposed solution and the anticipated outcomes. Lastly, the paper will touch on the dissemination of evidence for nursing practice.

Description of Solution: Best Practice Staffing

Best practice staffing is defined by the Emergency Nurses Association as “that which provides timely and efficient patient care and a safe environment for both patients and staff, while promoting an atmosphere of professional nursing satisfaction,” (Robinson, Jagim & Ray, 2004).

Based on best practice, staffing will be done taking into consideration the following factors: patient census, patients’ acuity, length of stay of patients, nursing time for interventions and activities by patient acuity, and the mix of registered nurses versus non-registered nurses’ skills.

The Implementation Plan and the Steps and Resources that will be Used

An automated tool (in this case an Excel workbook) will be used to calculate the number of fulltime equivalent (FTEs) that is needed to provide quality care to patients in the intensive care unit. The tool will then split the FTEs into a skills mix of registered nurses (86%) and non-registered nurses (14%). The ratio of RN to non-RN needed in intensive care units was determined by the Nursing Interventions Classification (NIC) system (Robinson et al., 2004).

Once the tool determines the total number of FTEs needed for the ICU patients, they will be distributed throughout the day according to the trends of the patient volume. This staffing technique based on best practice will enable the unit to acquire the appropriate number of nurses as well as support staff needed to provide utmost care to the ICU patients.

It is hoped that by having adequate nursing and support staff, the need to use physical restraints would be reduced drastically (Kielb, Hurlock-Chorostecki & Sipprell, 2005). Moreover, having adequate number of nurses and support staff will ensure that physically restrained patients do not go for hours without being checked.

In addition to best practice staffing, the solution will include a thorough observation of the patients. One important aspect of the action plan is the assertion that restraints or their alternatives should not be used as a substitute for observation. To enhance observation, the patients considered to be high-risk will be located in rooms that are closest to the nurse’s station.

Safety rounds and patient checks will then be done after every one hour, with more frequent safety rounds at highly risky times (for instance during shift change). Documentation will be part and parcel of the assessment procedure. The documentation of the patient’s physical, emotional and psychological state will be done after every assessment.

The records will be inserted in each patient’s folder and placed at the bedside for easy access by the nurse. As a result, the number and severity of injuries that often result from physical restraints’ use would also decline (Winston, Morelli, Bramble, Friday & Sanders, 1999).

Evaluation Plan

The effectiveness of the action plan can be evaluated through quality assurance indicators that include the attitudes of the medical staff towards physical restraints use, types and number of patients’ injuries, and number of patients who have been restrained before and after the program.

The attitudes of the medical staff towards restraint use will help to gauge the effectiveness of the education program offered within the program. The number of staff who favored the use of restraints before the program will be compared with the number of staff favoring restraint use after the program.

The evaluation plan will be conducted through data collection using questionnaires as well as from medical records of the patients. As a result, the resources needed include human resources to carry out the actual data collection and statistical tools to analyze the data.

The projected outcomes from this plan are many. First and foremost, it is expected that the attitudes of the nurses towards ICU patients will be more positive than was the case before the plan’s implementation. This is due to reduced work load resulting from an increase in the number of staffs in the organization.

Second, it is expected that fewer patients will be physically restrained because physical restraints will be used only in extreme circumstances. Third, it is expected that the number and severity of injuries that result from physical restraints will reduce.

Dissemination of Evidence

Dissemination of evidence for nursing practice can be done in a number of ways. First, conferences organized for the nursing professionals are a great channel of disseminating evidence as they allow for extensive discussion of the evidence and criticism from peers.

Second, the evidence can be disseminated through publications in professional journals, periodicals, organizations’ newsletters, books, newspapers and magazines. Publication in peer-reviewed journals is the best option because experts in the field can criticize and appraise the evidence thus making it more credible.

The evidence can be published in various journals including: The Journal of Aging & Social Policy, Pre-hospital Emergency Care, Journal of Nursing Scholarship, and Journal of Nursing Practice to mention but a few. I would choose the Journal of Nursing Practice to disseminate the evidence. This is because this journal covers a wide range of topics in the nursing field practice and is therefore not as limited as the rest. As a result, the journal has a higher readership rate than the rest.

Conclusion

Based on evidence from the literature, this paper has provided a solution for the problem of physical restraints in the intensive care units. The paper has also presented an implementation plan of the solution as well as the means through which the evidence can be disseminated.

Reference List

Kielb, C., Hurlock-Chorostecki, C., & Sipprell, D. (2005). Can minimal patient restraint be safely implemented in the intensive care unit? Canadian Association of Critical Care Nurses, 16(1), 16-19.

Robinson, K., Jagim, M., & Ray, C. (2004). Nursing workforce issues and trends affecting emergency departments. Topics in Emergency Medicine, 26(4), 276-286.

Winston, P. A., Morelli, P., Bramble, J., Friday, A., & Sanders, J. B. (1999). Improving patient care through implementation of nurse-driven restraint protocols. Journal of Nursing Care Quality, 13(6), 32-46.

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