Implementation of a Physical Restraint Decision Tree on Reducing Physical Restraint Use in an Adult Intensive Care Unit

OBJECTIVE: To construct and evaluate a decision tool that minimizes physical restraint (PR) use while maintaining positive patient outcomes in an adult intensive care unit (ICU). It also aimed to understand nurses' perspectives regarding implementing the decision tool into routine ICU practice. DESIGN: A mixed-method design. METHODS: This study employed a mixed-method design, consisting of a Delphi study to develop a physical restraint decision tree (PRDT), a quasi-experimental study to evaluate the effect of PRDT on minimizing PR use in an adult ICU, and a qualitative interview to understand nurses' perspective and satisfaction of using the PRDT in daily practice. We compared the data on PR use and patient outcomes before and after applying the PRDT in an ICU. RESULTS: The PR rate was 48.1% before applying the PRDT from January to June 2018, significantly dropped to and maintained at 10.1% after implementing the PRDT from October 2018 to December 2022. After the implementation of the PRDT, the average length of ICU stays significantly reduced from 4.66 to 3.71 days; the average daily cost of ICU stays per patient dropped from 5084.13 CNY to 4312.02 CNY. No adverse events, such as catheter extrusion and fall, had occurred. Nurses encountered high satisfaction regarding integrating the PRDT into ICU practice. CONCLUSIONS: The PRDT provides a structured, evidence-based approach to guide clinical decisions of lowering PR use in daily ICU practice. Implementation of the PRDT significantly reduced PR use without increasing adverse events. IMPLICATIONS FOR CLINICAL PRACTICE: The PRDT can serve as a tool for standardizing practices across the ICU, ensuring that restraint use is consistent with best practice guidelines and minimizing variability in care. REPORTING METHOD: SQUIRE 2.0 guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.