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PMID:31487137
Abstract

Hospitals operate with the primary goal of improving the health of individuals who seek health care services. Despite this, a small proportion of patients experience unintended harm during their hospital stay; 37% of these adverse events are considered preventable. Older adults are particularly vulnerable to adverse events during their hospital stay as they tend to be frailer and have more comorbidities than their younger counterparts. In particular, falls in the hospital setting are three times more likely than in the community. The ideology of restraint use is to prevent patients from harming themselves (e.g., patient is a high risk for sustaining a fall) or others (e.g., patient displays dangerous behaviour towards care staff or other patients). Restraints are often described as a chemical or a physical restraint. Chemical restraints can be thought of as pharmacologic drugs, such as antipsychotics and benzodiazepines. Physical restraints are “mechanical devices, materials, or equipments which restrict freedom of movement or normal access to one’s body.” Examples of physical restraints include wrist and ankle restraints, bed rails, lap belts, and chairs with table trays that prevent patients from rising. Restraint use has been ethically debated for decades, largely because it inhibits patients’ autonomy and dignity. Studies conducted in the long-term care setting found no evidence that restraint use reduces falls and restraints may increase the presence of pressure ulcers. Moreover, the Government of Ontario released the Patient Restraints Minimization Act in 2011 to “minimize the use of restraints on patients and to encourage hospitals and facilities to use alternative methods, whenever possible, when it is necessary to prevent serious bodily harm by a patient to himself or herself or to others.” Despite this, evidence around clinical effectiveness for the use and avoidance of physical restraints among older adults in the hospital setting is less clear. Synthesized evidence about physical restraints within the hospital setting is required to inform best practices. Thus, this report aims to summarize the evidence regarding the clinical effectiveness and evidence-based guidelines for the use or avoidance of physical restraints among hospitalized older adults.

摘要

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