Impact of the restraint decision tree for physical restraint use in South Korean neurointensive care units

Background: Nurses in neurointensive care units (NCUs) commonly use physical restraint (PR) to prevent adverse events like unplanned removal of devices (URDs) or falls. However, PR use should be based on evidenced decisions as it has drawbacks. Unfortunately, there is a lack of research-based PR protocol to support decision-making for nurses, especially for neurocritical patients. Aim: This study developed a restraint decision tree for neurocritical patients (RDT-N) to assist nurses in making PR decisions. We assessed its effectiveness in reducing PR use and adverse events. Study Design: This study employed a baseline and post-intervention test design at a NCU with 19 beds and 45 nurses in a tertiary hospital in a metropolitan city in South Korea. Two-hundred and thirty-seven adult patients were admitted during the study period. During the intervention, nurses were trained on the RDT-N. PR use and adverse events between the baseline and post-intervention periods were compared. Results: Post-intervention, total number of restrained patients decreased (20.7%–16.3%; χ² = 7.68, p =.006), and the average number of PR applied per restrained patient decreased (2.42–1.71; t = 5.74, p <.001). The most frequently used PR type changed from extremity cuff to mitten (χ² = 397.62, p <.001). No falls occurred during the study periods. On the other hand, URDs at baseline were 18.67 cases per 1000 patient days in the high-risk group and 5.78 cases per 1000 patient days in the moderate-risk group; however, no URD cases were reported post-intervention. Conclusions: The RDT-N effectively reduced PR use and adverse events. Its application can enhance patient-centred care based on individual condition and potential risks in NCUs. Relevance to Clinical Practice: Nurses can use the RDT-N to assess the need for PR in caring for neurocritical patients, reducing PR use and adverse events.