Short Term Outcomes of the Use of Physical Restraints of Delirious Patients at Intensive Care Units

• Main Authors: Chen, Mei-Chen, 陳美偵
• Other Authors: Wang, Jeng
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/43083888383301643461

碩士 === 長庚科技大學 === 護理研究所 === 101 === Background The development of delirium is associated with prolonged use of mechanical ventilators, extended length of stay, and higher mortality rates among the intensive care unit (ICU) patients. The usage of physical restraints in patients with delirium is commonly seen at ICU; however, without closely monitoring, patients could be harmed by use of the physical restraints, which lead to further physical and mental injuries, even deaths. Purpose Three main purposes of this study are: 1) to establish the incidence rate of delirium and it risk factors among ICU patients; 2) to explore the short-term outcomes (one month) of patients with delirium; 3) to establish the incidence rate of the sue of physical restraints and its risk factors among delirious patients at ICU; 4) to explore the short-term outcomes (one month) of delirious patients using physical restraints. Methods A total of 110 consecutive patients admitted to an ICU of a tertiary referral hospital between June 1 and October 31 2012 were recruited. The Confusion Assessment Method for the Intensive Care Unit was used to recognize the development of delirium. The occurrence of delirium and physical restraints were evaluated twice a day (7AM & 7PM) for up to seven consecutive days. The short- term outcomes were defined as durations of the used of mechanical ventilators, length of ICU stay, as well as direct hospital costs. The multivariate logistic regression was used to identify the risk factors of the development of delirium and the use of physical restraints. Results There were 55 (50%) subjects developing delirium. The most common type of delirium was hypoactive (52.7%), followed by mixed (29.1%) and hyperactive (18.2%). Totally, 82.7% of the patients developing delirium were within first 24 hours admitted to ICU. Patients with delirium are more likely to receive physical restraints those without (83.6% vs. 16.4% , p <.001); those with delirium tend to get restraints longer than those without delirium (5.41 ± 6.3 vs. 0 ± 0 days, p <.001 ) Factors associated with the occurrence of delirium include APACH II score s(95% CI: 1.07 ~ 1.79, OR=1.38, p=.013), unclear day and night (95% CI: 6.7 ~ 21675.5, OR=381.06, p=.004), and physical restraints (95% CI: 2.62 ~ 36078.34, OR=307.36, p=.018 ). The short term outcomes of those having delirium were longer use of mechanical ventilators, prolonged days of length of ICU stay (p<. 001), and higher hospital costs (p<.001) than those not having delirium. Moreover, among patients with delirium, the usage of physical restraints are associated with longer use of mechanical ventilators (p<.001), and length of ICU stay (p<.001) than those not restrained. Conclusions/Implications for practice High incidence rates of both delirium and the use of physical restraints in the ICU patients were established. The use of physical restraints does not only predict the development of delirium, but also is associated with longer use of mechanical ventilator, and length of ICU stay. Nurses should carefully assess the necessity of the use of physical restraints, especially for patients having delirium, since the short-term outcomes of delirious patients using physical restraints are poor. An education program should be established for ICU nurses to improve their knowledge about how to identify delirium, risk factors related to delirium, and adverse effects of use of physical restraints.