de Boer Liesbeth, Scheepers Jeroen, Vertommen Christianne, Klein Dorthe O, Rietbergen Tessa, Bal Roland A
Department of Nursing, Maastricht UMC+, Maastricht, Limburg, Netherlands
Department of Psychiatry, Maastricht UMC+, Maastricht, Netherlands.
BMJ Open Qual. 2025 May 30;14(2):e003046. doi: 10.1136/bmjoq-2024-003046.
During a patient's hospital stay, restraint use in the Netherlands-defined as 'interventions that have restrictive consequences for the individual freedom of patients'-may be necessary to protect the individual from harm, provided it is applied proportionally, effectively, safely and with subsidiarity. Restraint use can have physical and psychological effects on patients and should therefore only be used when necessary and in accordance with established guidelines and regulations. In the Netherlands, five categorisations of restraints are used. The least invasive restraints are classified in category 1, and the most restrictive are classed into category 5. Accurate documentation is crucial to gain insight into restraint use, but it is often lacking. The aim of the project was to improve the documentation of restraint use for adult patients on a general nursing ward in a Dutch academic hospital. Three Plan-Do-Study-ACT (PDSA) cycles with follow-up measurements were undertaken to assess whether documentation was carried out correctly and completely.Medical record review (describing indication, consultation with a second nurse and physician, consent of the patient's and/or legal representative and applied restriction) has been conducted to establish the baseline measurement.The first PDSA cycle started after implementing a new form of documentation. The second PDSA cycle was performed after implementing a multifaceted intervention to improve documentation and increase knowledge on restraint use among nursing and medical staff. The third and final PDSA cycle took place after the medical record reviews were conducted and communicated to the leaders of the nursing teams. The nursing teams were asked to focus on restraint use at the departmental level.Introducing a new form of documentation for restraint use improved documentation from 0% to 55.9% during the course of the study.
在患者住院期间，在荷兰，约束措施的使用——定义为“对患者个人自由产生限制后果的干预措施”——可能是保护个人免受伤害所必需的，前提是其应用合理、有效、安全且具有辅助性。约束措施的使用会对患者产生身体和心理影响，因此应仅在必要时并按照既定的指南和规定使用。在荷兰，约束措施分为五类。侵入性最小的约束措施归为第1类，限制最大的归为第5类。准确记录对于了解约束措施的使用情况至关重要，但往往缺乏记录。该项目的目的是改善荷兰一家学术医院普通护理病房成年患者约束措施使用情况的记录。进行了三个带有后续测量的计划-实施-研究-改进（PDSA）循环，以评估记录是否正确且完整。已进行病历审查（描述指征、与第二名护士和医生会诊、患者和/或法定代表人的同意以及应用的限制措施）以建立基线测量。在实施一种新的记录形式后开始了第一个PDSA循环。在实施多方面干预以改善记录并增加护理和医务人员对约束措施使用的了解后进行了第二个PDSA循环。在进行病历审查并将结果传达给护理团队负责人后进行了第三个也是最后一个PDSA循环。要求护理团队在科室层面关注约束措施的使用。在研究过程中，引入一种新的约束措施使用记录形式使记录率从0%提高到了55.9%。
