Increase nurse staffing to reduce use of patient restraints


Patients are less likely to be put in restraints when hospitals have more registered nurses on duty, new research has found.

A study published in the Journal of General Internal Medicine found that the higher the average percent of registered nurses were on a shift, the less likely that staff would use patient restraints. When hospitals had low or very low numbers of registered nurses on duty, patients were 11 percent and 18 percent, respectively, more likely to be put in restraints.

Hospitals with fewer nurses on duty were also more likely to restrain patients believed to be at risk for falls. 

Researchers say the findings suggest that the proportion of nursing care provided by the registered nurses mix rather than the total staffing level is the more important predictor of restraint use.

“Nurses must obtain a physician order for a restraint, and having an adequate proportion of RNs apparently reduces the likelihood of nursing staff requesting such an order, perhaps because RNs are better trained to find alternatives to restraint,” the researchers concluded.

The study sifted through data on more than 923,000 patients at 869 U.S. hospitals, which was gathered between 2006 and 2010 through the National Database of Nursing Quality Indicators.

"The findings suggest that patient care quality may suffer when unit staffing models cannot respond to changes in patient volume or registered nurse availability except by increasing the hours of staff who are not registered nurses," lead author Vincent Staggs, Ph.D., of Children's Mercy Hospital and the University of Missouri-Kansas City, said in a survey announcement. "This is further evidence that the type of nursing staff, not just the number of staff per patient, can be important for patient outcomes."

Use of patient restraints has fallen out of favor with providers in recent years, FierceHealthcare has previously reported, amid concerns that the practice is unsafe and may actually harm patients--even leading to their deaths. The Centers for Medicare & Medicaid Services has strict guidelines for restraint use, calling for clinicians to closely monitor patients and use the least restrictive restraints possible for each case.

- here’s the study
- read the announcement
- view the CMS guidelines (.pdf)