Leadership Strategy Analysis Paper

Leadership Strategy Analysis
Leigh Anne Koonmen

Identifying a clinical need: Patient injury/death due to restraints
Nurses in acute rehabilitation settings use physical restraints on patients to prevent falls
and manage impulsive and agitated behavior
Up to 34% of patients in rehabilitation settings who fall do so while physically restrained
Previous studies have found that decrease use of restraints have been correlated with
decreased injurious falls
Interdisciplinary Care
Physicians
o Order alternative methods to restraint use and only order restraints when
absolutely necessary
o Prompt face-to-face evaluation when restraints are ordered
Unit Managers
o Provide education on alternative methods of restraint use, risks associated with
restraint use, and counsel on appropriateness of restraint use based on individual
situation
o Debrief with healthcare staff when restraints are used and the effectiveness of the
intervention; identify any possible interventions that could have been utilized to
prevent restraint necessity (e.g. were needs met?)
Nursing staff
o Utilize alternative methods to restraint use
o Frequent assessment of patients risk for falls and self-injury
Assess risk ratio of restraint use benefits to potential for injury
o Frequent monitoring of patient in restraints, assess need for continuation of
restraints frequentlydiscontinuation of restraints as soon as assessment shows
they are no longer necessary
o Work with patients to identify need for assistance to reduce impulsive behavior
Physical therapists
o Work with patients on proper safety techniques when ambulating and performing
ADLs
Occupational therapists
o Work with patients to find alternative activities when feeling agitated or restless
Nursing assistants/aids
o Respond promptly to call-lights and bed/chair alarms
o Frequent checks (at least hourly) to assess needs (e.g. toileting, ambulation,
ADLs)
o Use of assistive devices and safety precautions during ambulation (e.g. canes,
walkers, gait belts, standby assist)
o Frequent monitoring for orthostatic hypotension (e.g. asking patient about

lightheadedness/dizziness, watching for objective signs and symptoms)
o Frequent monitoring or one-to-one monitoring of patients in restraints
Pharmacists
o Work with physician and nursing staff to identify proper medications and dosages
of PRN and scheduled medications to decrease impulsive or agitated behavior
Proposed Method of Collecting Data
Monitor and analyze documentation and incidence reports related to the use of physical
restraints in addition to the frequency of placed orders for physical restraints and how
often those orders are utilized
o Collect data prior to implementation of a Restraint Reduction Program (RRP) and
after completion of the RRP
Questions to ask to guide data collection:
o How frequently are restraint related falls occurring?
o What population is experiencing restraint related falls and injuries most?
o Were alternative methods used prior to initiating restraints?
What were these methods?
What made them ineffective?
o What behaviors precipitated the need for restraints?
Could this have been prevented? (e.g. by identifying and managing unmet
needs)
o What are the organizations policies regarding restraint use?
Were these policies followed?
What evidence-based research are these policies founded on?
o What kind of training have the healthcare professionals received in regards to
restraint use?
Expected Outcomes
Healthcare providers will

o be able to identify alternative means to restraint use
o be able to identify risks associated with restraint use
o be trained on proper use of restraints
o be familiar with the organizations policies on restraints
Restraint use within the organization will be reduced, as will restraint related falls and
injuries
Patient needs will be met by frequent interdisciplinary monitoring in order to prevent
precipitating behaviors necessitating restraint use (e.g. agitation and impulsivity)
References
Amato, S., Salter, J.P., Mion, L.C. (2006). Physical restraint reduction in the acute
rehabilitation setting: A quality improvement study. Rehabilitation Nursing (31)
6. 235-241.
Butterworth, R. & Harbison, I. (2011) Restraint and never events: An opportunity for
Mental Health Practice. (15) 1. 30-32.
Tzeng, H.M. & Yin, C.Y. (2012). Physical restraint use rate and total fall and injurious
rates: An exploratory study in two US acute care hospitals. Open Journal of
Nursing (2). 170-175.

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Leadership Strategy Analysis

Leigh Anne Koonmen

o Frequent monitoring for orthostatic hypotension (e.g. asking patient about

Proposed Method of Collecting Data

Healthcare providers will

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