Medidas de restricción física en un hospital de agudos y en dos centros de media y larga estancia: estudio de prevalencia y análisis de aspectos éticos relacionados con su indicación y puesta en práctica

[Impact of family restrictions during COVID-19 pandemic on the use of physical restraint in an acute hospital: An observational study]

INTRODUCTION

During the worldwide pandemic of COVID-19 caused by coronavirus SARS-CoV-2, hospitals developed contingency plans that transformed and reorganized the hospital activity. One of the measures was to restrict access to family members of hospitalized patients. The presence of the patient's family is considered an alternative to physical restraint. The aim of this study is to compare the use of physical restraint in hospitalized patients in an acute care hospital during the previous period of the pandemic of COVID-19 with the post-confinement period with hospitals being still closed to family.

MATERIAL AND METHODS

We made an observational study that compares the prevalence of physical restraint in an acute care hospital during the previous period to the alarm state (February 2020) with the second period, when visits where restricted (May 2020). From the clinical history of the patients with physical restraint we collected the following variables: sex, diagnostic, hospital admission unit, reason for using physical restraint, localization, length, type of material, registration in the medical record, information given to the family, alternatives to the physical restraint and injuries related to the physical restraint.

RESULTS

We evaluated 690 patients: 388 during the previous period and 320 during the second period. From all patients, 29 needed physical restraint. The use of physical restraint went from 8 (2%) to 21 (7%) (p=0.003). In the second period, a not statistically significant increase in continuous physical restraint was identified compared to the first period.

CONCLUSIONS

The physical restraint prevalence has been superior during the second period in which families were not present with the hospitalized patients.

[Safety problems associated with using physical restraint devices on the elderly]

The use of physical restraint devices on frail elderly could have significant negative consequences on their health. Apart from complications due to prolonged immobility, the use of this procedure is associated with other serious adverse effects which occur when a person is restricted in a position which carries a risk of asphyxiation. The devices most implicated in these incidents are bedrails, vests and restraining belts. Physical restraint could also be associated as much with the sudden death of patients, due to the stress that it causes, as with injuries from falling. This article presents the recommendations which experts, manufacturers and institutions dealing with the quality of health care have issued for the safest use of this procedure. It stresses the need for better training of professionals, as well as the importance of investigating the factors which can lead to accidents with the aim of preventing them.

[Use of physical restraints in an elderly population living in public nursing homes]

OBJECTIVE

To determine the prevalence of the use of physical restraints in public nursing homes through the Residents' Functional Classification Information System in order to assess the introduction of a protocol designed to reduce and rationalize the use of these devices.

MATERIAL AND METHODS

Twenty-five public nursing homes in the autonomous region of Madrid were included in this study. The following data on the use of physical restraints were analysed: frequency of use (daily or less than daily), type of device, level of functional dependence for activities of daily living, and severity of cognitive impairment.

RESULTS

A total of 5346 residents were included. The prevalence of the use of restraints was 8.4%. When the use of bedrails was added, this percentage rose to 20.8%. Bedrails accounted for 63.4% of all restraints used, trunk restraints for 17.7%, limb restraints for 3%, and chairs preventing voluntary rising for 15.9%. A single device was used in 62.6%. Of the restraints, 71.4% were used daily and 28.6% were used temporarily.

CONCLUSIONS

The results of this study represent an approximation to the current use of physical restraints in nursing homes. The prevalence found was similar to, or less than, that observed in previous studies. The most commonly used form of restraint was bedrails. The use of these devices is probably excessive, affecting even residents without cognitive impairment or physical dependence. To reduce the use of restraints and guarantee optimal care when their application is indicated, the Regional Social Welfare Service systematically applies a protocol for the prevention and use of physical restraints.

[Descriptive study of the attitudes of family caregivers to the use of physical restraints: preliminary results]

OBJECTIVE

To evaluate the attitudes of families caring for elderly dependents to the use of physical restraints and to identify the factors that could influence these attitudes.

MATERIAL AND METHODS

A descriptive, cross sectional study was carried out in a consecutive sample of the population, using a questionnaire investigating the various aspects that influence attitudes to restraints. Responses were obtained from 50 family caregivers, of which seven were discarded due to lack of knowledge about restraints (N=43). The characteristics of the sample, frequencies, the main trends and dispersion measures were analyzed.

RESULTS

Most of the family caregivers considered the use of restrains to be appropriate and 90.7% were willing to use them with a relative; 41.9% believed that their use was unavoidable and were unaware of alternatives, while 23.3% were unaware that physical restraints can cause physical and psychological problems. None of the family caregivers believed that this method of restraint was a form of abuse.

CONCLUSIONS

Relatives had a positive attitude to physical restraints and considered their use appropriate. This finding could be related to their limited knowledge of alternatives and of the complications that can be caused by restraints. Training programmes on alternatives to these devices should be instigated.