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Erschienen in: Internal and Emergency Medicine 4/2018

17.06.2017 | EM - ORIGINAL

Mechanical restraint in an emergency department: a consecutive series of 593 cases

verfasst von: Nicolas Beysard, Bertrand Yersin, Pierre-Nicolas Carron

Erschienen in: Internal and Emergency Medicine | Ausgabe 4/2018

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Abstract

The objective is to describe the characteristics of mechanically restrained patients in the emergency department (ED) of a university hospital and to evaluate the quality of restraint documentation that was filled out according to the dedicated protocol with respect to the law on restraint. All adult patients (≥16 years) who were admitted to the ED from January 2009 to December 2010 and were mechanically restrained were included. We assessed medical and demographic characteristics, the completeness of the dedicated protocol, and the concomitant use of chemical sedation. 72,844 patients were admitted to the ED. Of these, 593 (0.81%) were mechanically restrained. Two types of patients were restrained: young patients under the influence of psychoactive substances who were usually discharged home, and confused older patients who were hospitalized. 186 dedicated protocols were missing (31.4%). From the 407 filled-out protocols, only 119 (29.2%) were complete. Of the mechanically restrained patients, 215 (36.2%) received additional chemical sedation. Even though restraint is strictly regulated by law, many protocols justifying the privation of liberty were not filled out. This emphasizes the need for strict respect of the dedicated protocol and the use of guidelines and training sessions for nursing and medical staff that address specific procedures for the two categories of patients needing to be restrained.
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Literatur
3.
Zurück zum Zitat Nobay F, Simon BC, Levitt MA, Dresden GM (2004) A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med 11:744–749CrossRefPubMed Nobay F, Simon BC, Levitt MA, Dresden GM (2004) A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients. Acad Emerg Med 11:744–749CrossRefPubMed
5.
Zurück zum Zitat Richards JR, Derlet RW, Duncan DR (1998) Chemical restraint for the agitated patient in the emergency department: lorazepam versus droperidol. J Emerg Med 16:567–573CrossRefPubMed Richards JR, Derlet RW, Duncan DR (1998) Chemical restraint for the agitated patient in the emergency department: lorazepam versus droperidol. J Emerg Med 16:567–573CrossRefPubMed
8.
Zurück zum Zitat Huf G, Coutinho ES, Adams CE, Group T-SC (2012) Physical restraints versus seclusion room for management of people with acute aggression or agitation due to psychotic illness (TREC-SAVE): a randomized trial. Psychol Med 42:2265–2273. doi:10.1017/S0033291712000372 CrossRefPubMed Huf G, Coutinho ES, Adams CE, Group T-SC (2012) Physical restraints versus seclusion room for management of people with acute aggression or agitation due to psychotic illness (TREC-SAVE): a randomized trial. Psychol Med 42:2265–2273. doi:10.​1017/​S003329171200037​2 CrossRefPubMed
11.
Zurück zum Zitat Enns E, Rhemtulla R, Ewa V, Fruetel K, Holroyd-Leduc JM (2014) A controlled quality improvement trial to reduce the use of physical restraints in older hospitalized adults. J Am Geriatr Soc 62:541–545. doi:10.1111/jgs.12710 CrossRefPubMed Enns E, Rhemtulla R, Ewa V, Fruetel K, Holroyd-Leduc JM (2014) A controlled quality improvement trial to reduce the use of physical restraints in older hospitalized adults. J Am Geriatr Soc 62:541–545. doi:10.​1111/​jgs.​12710 CrossRefPubMed
12.
Zurück zum Zitat Cannon ME, Sprivulis P, McCarthy J (2001) Restraint practices in Australasian emergency departments. Aust N Z J Psychiatry 35:464–467CrossRefPubMed Cannon ME, Sprivulis P, McCarthy J (2001) Restraint practices in Australasian emergency departments. Aust N Z J Psychiatry 35:464–467CrossRefPubMed
13.
Zurück zum Zitat Gerace A, Pamungkas DR, Oster C, Thomson D, Muir-Cochrane E (2014) The use of restraint in four general hospital emergency departments in Australia. Aust Psychiatry 22:366–369. doi:10.1177/1039856214534001 CrossRef Gerace A, Pamungkas DR, Oster C, Thomson D, Muir-Cochrane E (2014) The use of restraint in four general hospital emergency departments in Australia. Aust Psychiatry 22:366–369. doi:10.​1177/​1039856214534001​ CrossRef
14.
Zurück zum Zitat Chapman R, Ogle KR, Martin C, Rahman A, McKenna B, Barnfield J (2016) Australian nurses’ perceptions of the use of manual restraint in the Emergency Department: a qualitative perspective. J Clin Nurs 25:1273–1281. doi:10.1111/jocn.13159 CrossRefPubMed Chapman R, Ogle KR, Martin C, Rahman A, McKenna B, Barnfield J (2016) Australian nurses’ perceptions of the use of manual restraint in the Emergency Department: a qualitative perspective. J Clin Nurs 25:1273–1281. doi:10.​1111/​jocn.​13159 CrossRefPubMed
15.
Zurück zum Zitat Chapman R, Martin C, Rahman A, Barnfield J, McKenna B (2015) The use of manual restraint in the emergency department, do we really know what’s going on? Int Emerg Nurs 23:109–111CrossRefPubMed Chapman R, Martin C, Rahman A, Barnfield J, McKenna B (2015) The use of manual restraint in the emergency department, do we really know what’s going on? Int Emerg Nurs 23:109–111CrossRefPubMed
19.
Zurück zum Zitat Funk M et al (2005) The resource book on mental healh, human rights and legislation. World Health Organization, Geneva Funk M et al (2005) The resource book on mental healh, human rights and legislation. World Health Organization, Geneva
25.
28.
Zurück zum Zitat van der Zwan R, Davies L, Andrews D, Brooks A (2011) Aggression and violence in the ED: issues associated with the implementation of restraint and seclusion. Health Promot J Austr 22:124–127CrossRefPubMed van der Zwan R, Davies L, Andrews D, Brooks A (2011) Aggression and violence in the ED: issues associated with the implementation of restraint and seclusion. Health Promot J Austr 22:124–127CrossRefPubMed
31.
Zurück zum Zitat Niquille M, Gremion C, Welker S, Damsa C (2007) Agitation in prehospital setting: view of emergency physicians. Rev Med Suisse 3:1839–1846PubMed Niquille M, Gremion C, Welker S, Damsa C (2007) Agitation in prehospital setting: view of emergency physicians. Rev Med Suisse 3:1839–1846PubMed
32.
Zurück zum Zitat Nelstrop L, Chandler-Oatts J, Bingley W, Bleetman T, Corr F, Cronin-Davis J, Fraher DM, Hardy P, Jones S, Gournay K, Johnston S, Pereira S, Pratt P, Tucker R, Tsuchiya A (2006) A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short-term management of violence in adult psychiatric inpatient settings and emergency departments. Worldviews Evid Based Nurs 3:8–18. doi:10.1111/j.1741-6787.2006.00041.x CrossRefPubMed Nelstrop L, Chandler-Oatts J, Bingley W, Bleetman T, Corr F, Cronin-Davis J, Fraher DM, Hardy P, Jones S, Gournay K, Johnston S, Pereira S, Pratt P, Tucker R, Tsuchiya A (2006) A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short-term management of violence in adult psychiatric inpatient settings and emergency departments. Worldviews Evid Based Nurs 3:8–18. doi:10.​1111/​j.​1741-6787.​2006.​00041.​x CrossRefPubMed
36.
Zurück zum Zitat Zun LS (2003) A prospective study of the complication rate of use of patient restraint in the emergency department. J Emerg Med 24:119–124CrossRefPubMed Zun LS (2003) A prospective study of the complication rate of use of patient restraint in the emergency department. J Emerg Med 24:119–124CrossRefPubMed
37.
Zurück zum Zitat Cowling SA, McKeon MA, Weiland TJ (2007) Managing acute behavioural disturbance in an emergency department using a behavioural assessment room. Aust Health Rev 31:296–304CrossRefPubMed Cowling SA, McKeon MA, Weiland TJ (2007) Managing acute behavioural disturbance in an emergency department using a behavioural assessment room. Aust Health Rev 31:296–304CrossRefPubMed
Metadaten
Titel
Mechanical restraint in an emergency department: a consecutive series of 593 cases
verfasst von
Nicolas Beysard
Bertrand Yersin
Pierre-Nicolas Carron
Publikationsdatum
17.06.2017
Verlag
Springer International Publishing
Erschienen in
Internal and Emergency Medicine / Ausgabe 4/2018
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-017-1697-6

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