Increasing The Frequency Of Behavior Assessment To Reduce Physical Restraint

Authors

BreAnne N. Ford, University of Texas Health Science Center at HoustonFollow

Date of Doctor of Nursing Practice Project Completion

Spring 9-30-2024

Faculty Advisor

Marie McBee

Abstract

Purpose: The purpose of this quality improvement (QI) project was to implement a system that routinely assesses for behavior changes in psychiatric patients presenting to the emergency department to improve staff intervention of escalating behaviors and decrease physical restraint use.

Background: The project was implemented in a 45-bed emergency department in a community-based hospital affiliated with a large hospital system in Houston, Texas.

Methodology: The project utilizes the Behavioral Activity Rating Scale (BARS) to assess patients' behaviors at routine intervals throughout shifts and a comfort cart that houses several non-pharmacological intervention items to use to de-escalate adverse behaviors. The staff was educated on how to rate the patients’ behaviors and when to utilize non-pharmacological interventions prior to implementation. Visual reminder cards of when to assess and document patients’ BARS assessments were placed on the computers used by the nurses. Data on the frequency of BARS assessments, restraint use frequency, pharmacological and non-pharmacological intervention use, and Code Purple alert frequency was obtained pre- and post-implementation. The project followed the Plan-Do-Study-Act (PDSA) cycle.

Data Analysis: After implementing the QI project, the frequency of BARS assessments improved from an average rate of 1.76 assessments per patient to an average rate of 10.48 assessments per patient. Pre-implementation, there were three physical restraint events, and post-implementation, there were seven physical restraint events. Code Purple alerts increased 100% from the time captured 1 year before implementation.

Implications: Implementing frequent BARS assessments may increase nurses’ awareness of behavior changes, as evidenced by the increase in Code Purple Alerts. Although the goal of the intervention was to utilize non-pharmacological interventions to de-escalate adverse behaviors, the increased frequency of Code Purple alerts may be considered an additional form of non-pharmacological intervention. Nurses may feel more empowered to manage escalating behaviors through earlier identification and management of crises, thus improving patient safety and outcomes.

Keywords

behavioral activity rating scale, emergency department, aggression, behavior, comfort cart, intervention, physical restraint, mental health, psychiatric, early intervention

Recommended Citation

Ford, BreAnne N., "Increasing The Frequency Of Behavior Assessment To Reduce Physical Restraint" (2024). Doctor of Nursing Practice Final Project Abstract. 66.
https://digitalcommons.library.tmc.edu/dnp_abstract/66