Illinois Hospital Stays Restraint Free for Five Years

The Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, IL, believes in the "mother standard of care," or treating patients as if they are family members or "your own mother," says Kimberly Bertini, RN, Coordinator for the ANCC Magnet Recognition Program® at CTC.

For years, CTC used restraints on patients who became confused because of brain metastasis, chemotherapy brain, or a mixture of pain medications.

However, Bertini says staff members at CTC were uncomfortable using the restraints on patients, and many opted to stay overtime and sit with patients to refrain from using the restraints.

"We noticed the staffs' reaction to placing patients in restraints," says Bertini. "We decided it was time to make a change and actually begin treating patients like they are our mother."

In 2005, CTC gave up restraints altogether to mirror this belief and the culture of the organization. Since then, CTC continues to decrease patients' length of stay, falls, and has only had one outstanding case in which a patient needed restraints because of the danger posed to him- or herself.

Going restraint free
From the beginning, the administrative team at CTC was supportive of the decision to stop using restraints on patients, says Bertini.

"The administrative team saw this as a way to help empower the staff and let them take patient care into their own hands," she says.

CTC's first step to becoming restraint free involved increasing the number of staff. If a patient came in and fell under criteria for which a restraint might previously have been necessary, a patient care tech or sitter was assigned to the patient's room at all times.

"We decided not to hire sitters from an outside agency because of our culture," says Bertini. "It is hard bringing in an outside source and then having to teach [him or her] about our culture and beliefs."

By staying within CTC, the patient and family are already familiar with the staff member, and it helps the patient trust the caregiver.

In addition to having sitters available, CTC has bed alarms on every patient's bed. The bed alarm sounds an alert when there is a certain level of movement in the patient's bed or if a patient decides to climb out of bed at the foot because of raised side rails.

The bed alarm not only acts as an alert to the nurses if a patient is out and moving, it also helps patients inform their nurses that they have gotten up in the event they forget to hit the call button on their own.

"At CTC, our age range of patients is from 18 to 100," says Bertini. "We have patients in their 30s and 40s who are a fall risk and can forget to call a nurse when they attempt to use the bathroom, and this system helps everyone."

Additional measures
The use of sitters and bed alarms are only two of the strategies that CTC used to become restraint free, says Bertini. In addition to these tactics, staff also conducted mandatory hourly rounds. Prior to 2005, CTC staff conducted rounds, but there was no strict time period and they were not mandatory.

"The staff would round every hour to an hour and a half, and we could not guarantee even this," says Bertini.

Now, staff members make rounds at least every hour, and if the patient is at a higher risk level, the staff member will check in with the patient more often.

The staff also have a team check-in used in conjunction with the patient rounding that helps the nurse and primary care physician review the care plan of each patient for the day. At the beginning of the day, the PCP and the nurse sit down with the patient for five minutes and develop the care plan for the day.

For each patient, the team writes on a whiteboard ¬located in patients' rooms what the patient deems as important for the day, what the nurse needs to get done, and what the PCP has to accomplish. The plan also outlines any procedures the patient has that day.

"The plan allows everyone to be on the same page and provides a timeline for the day," says Bertini. "This way, if a patient wants a bath, the doctor can tell the patient it won't be until 4 p.m., and the patient isn't waiting around."

This also helps patients' family members stay in the loop regarding the kind of treatment their loved ones will be receiving.

"By CTC staff being so open and up front about the care the patient will receive, it is a relief for the family who may not know what to expect," says Bertini.