Decreasing Physical Restraint Use in the Emergency Department through Staff Education

Abstract

Purpose: This quality improvement project was developed to provide education regarding de-escalation techniques to nursing staff to reduce use of physical restraints through early identification of signs of agitation, knowledge of psychiatric diagnoses which are associated with higher likelihood of violence, and knowledge of illegal substances which are associated with higher likelihood of violence in Emergency Department (ED) at Banner University Medical Center South Campus in Tucson, Arizona. Background: Research has shown that physical restraint use is detrimental to both mental and physical health of patients and to mental health of nurses as well. Verbal de-escalation has been shown to reduce need for physical restraint use, and through nursing education on verbal de-escalate techniques for patients with varying degrees of agitation, restraint use can be avoided. Methods: ED nurses at Banner University Medical Center South Campus participated in an educational session that covered topics such as identification of substances that were found to be correlated to higher levels of agitation, psychiatric diagnoses more highly associated with violence, and patient characteristics which have been found to be associated with violence towards healthcare workers. Narrated PowerPoint presentation was provided to all staff nurses in the ED with post-intervention assessment to determine efficacy of learning module. Educational materials which summarized presentation were provided to ED leadership for future use and reference on unit. Results: Although a significant number of participants reported an increase in their confidence in using verbal de-escalation techniques, along with willingness to change their approach to de-escalation and use alternatives to physical restraints, results of post-intervention assessment were lower than 90% benchmark which was set to evaluate the efficacy of learning module. Results indicate that this type of educational module should be incorporated into staff education, but changes should be made to educational module so that information is conveyed more clearly to learner. Conclusions: This quality improvement project showed benefit to ED staff and should continue to be modified and utilized on this unit. ED leadership may use this information to gather restraint use data to further assess efficacy of this project in providing nurses with valuable skills and education.