Patients Benefit From Restraint-free Care

HCPro's Advisor to the ANCC Magnet Recognition Program®, May 25, 2010

Facilities across the country, whether they are ANCC Magnet Recognition Program® (MRP) designated hospitals, designation hopefuls, or just seeking to improve their quality of care, struggle daily with the challenges inherent to the use of restraints. For Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, the decision was made in 2005 to deal with restraints by simply going restraint-free.

"It was just a natural step under the Mother Standard® of care," says Kimberly Bertini, RN, MRP coordinator with CTCA at Midwestern. The Mother Standard of care is the organization's philosophy to treat every patient and caregiver "as if they are our own mother," says Bertini.

CTCA knew from the start that this needed to be a grassroots initiative with senior-level support because the plan to go restraint-free would involve increased hospital costs and an investment in "patient sitters"—which program organizers believed would be necessary to go restraint-free.

"At first it might have seemed taxing, but as we increased staff, we found having extra patient care techs able to sit with our patients rather than restraining them was not only easier for staff, but also for the patients and the patients' families," says Bertini.

Much of the work toward improvement could not have happened without the total support of leadership.

"Support from leadership naturally made this a very easy process," says Bertini.

Although the restraint-free concept can be implemented in this form at other types of healthcare facilities, at a cancer specialty hospital, there is a palpable difference based on what the patients are going through.

"Really, it's best practice," says Bertini. "We're at a cancer specialty hospital, and we were looking at the harm restraints can cause the patient—increasing confusion, bedsores, and falls."

The first step was to identify nursing staff to lead the program development.

"With every one of our nursing stakeholders delivering Patient Empowerment Medicine®, this was no problem," says Bertini. The organization strives to provide autonomy and empowerment for the nursing team to bring evidence-based practice to the bedside in their day-to-day delivery of care.

Leading the team was Carol Labanco, RN, of the ICU, Sue Wolf, RN, and Josephine Mezger, RN, of the oncology unit. They provided the literature review, wrote the practice guidelines, and created the educational plan to roll out the program to the nursing team. Carmelita Zeta-Sanchez, director of nursing, was the program champion, serving as the patient and nursing voice to the hospital CEO, Anne Meisner, MSN. Zeta-Sanchez encouraged the team to leverage nonproductive hours to develop the program. Sharon Dimitrijevich, manager of the ICU and ED, gave the team guidance, support, and structure.

"The staff nurses who implemented the evidence-based practice conducted a lot of research when they wrote the policy. There was a mass education effort for nurses. Patient safety and satisfaction is our goal at all times," says Dimitrijevich. "We not only reviewed the policy, but also implemented mock scenarios on how the program would work for the patient experiencing simple confusion to the emergency department patient who is striking out and endangering staff." This education took examples from one extreme to the other to prepare staff for a live environment.

"Our goal at the time for the nursing education effort was an ability to implement an immediate stop of restraint use when we went live," says Bertini. "This was a natural evolution of the Mother Standard of care and a living example of delivering Patient Empowerment Medicine."

This means putting the power to make change in the right hands.

"When looking at best practices, we empower the nurses—give them the ball and let them run with it," says Bertini.

CTCA achieved its goal of becoming restraint-free in 2005 and has maintained the program at a 100% accuracy rate to date.

"We report this benchmark indicator nationally to the National Database of Nursing Quality Indicators quarterly and monthly to the hospital board of directors," says Bertini. "Both reports are disseminated to our nursing team."

By delivering Patient Empowerment medicine, CTCA empowers patients and family members to be at the core and center of their own treatment.

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