Hospitals should reconsider whether physical restraints are a good tool to use, especially in the intensive care unit (ICU) as they could be ineffective or harmful in some situations, writes author Ravi Parikh in an article in The Atlantic.
Medicare guidelines recommend hospitals use restraints only when patients pose a threat of violence to themselves or others or disrupt life-saving therapies such as breathing tubes. Parikh, a resident in internal medicine and primary care at Brigham and Women's Hospital in Boston, noted that doctors and nurses often use restraints when the patients are delirious or at risk of falling, but cites studies that restraints can increase anxiety, rates of pressure ulcers, respiratory complications and death by strangulation and aspiration.
The majority of intensive care unit patients don't need restraints, Parikh noted. "However, as one of my senior residents confided in me, when caring for the sickest patients in the hospital, restraining a delirious patient might be the only way to devote time to other seriously ill patients," he wrote.
Instead, hospitals can use devices such as shields around central line sites to protect the IV without restricting patient movement, or design restraint-free wards by providing mobility aids in all rooms so patients can move around when they want to, as highlighted in recommendations released by the American Geriatrics Society earlier this year.
Parikh recalled a night during his residency rotation where instead of restraining a patient, the medical team in the ICU reoriented the patient by reminding him where he was and the time of day, offered him medication to treat his anxiety, and called his wife and put her on the telephone to provide a familiar voice. "The patient eventually calmed down without the need for restraints or other aggressive interventions, and the next morning his mental status improved," he wrote. "I hope that stories like his can become the standard, not the exception, in the ICU."