Improving accurate documentation for reducing restraint use: a quality improvement project in a Dutch academic hospital

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.