SHM Converge Scientific Abstract ePoster Gallery-Mechanical Restraints in Patients Not Receiving Antipsychotics: A Retrospective Analysis

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This retrospective cross-sectional study examined adult admissions to a large academic hospital from August 2018 to February 2020 to better understand which patients were placed in mechanical restraints without receiving antipsychotics. After excluding ICU patients, the study reviewed 23,366 admissions.<br /><br />Among all patients, 408 received mechanical restraints. Restraint use was strongly associated with delirium, measured by the brief Confusion Assessment Method (bCAM), and with antipsychotic use. Patients who were bCAM positive and received antipsychotics had the highest likelihood of restraint use, while bCAM-positive patients who did not receive antipsychotics still had increased risk compared with bCAM-negative patients.<br /><br />The in-depth chart review focused on 55 bCAM-positive patients who were mechanically restrained but did not receive antipsychotics. These patients were mostly male, had longer hospital stays, and a notable proportion were discharged to hospice or other end-of-life care settings. Most received benzodiazepines during hospitalization, which may worsen delirium. Only a small minority had a documented contraindication to antipsychotics, such as QT prolongation or prior adverse effects.<br /><br />The authors found no clear racial bias in the use of mechanical restraints without antipsychotics, but men were more likely to receive this intervention. They also observed that first restraint orders clustered around shift changes and overnight hours, suggesting possible opportunities for nursing and resident education and restraint reduction efforts.<br /><br />Overall, the study highlights that mechanical restraints are used in a small but important subset of delirious patients, often without a strong documented reason for avoiding antipsychotics. The authors conclude that better understanding of this population is a necessary step toward reducing potentially harmful restraint use and improving delirium management.

Asset Subtitle

George Book

Meta Tag

Author List Benjamin Kalivas, George Book, Jingwen Zhang, Justin Marsden, Meghan Thomas

Category Research

Concept Mechanical Restraint

Concept Antipsychotic

Concept Retrospective Cross-Sectional Study

Concept Delirium

Concept bCAM

Distinguished Non-Finalist

Presenter Organization Medical University of South Carolina

Presenting Author George Book

Track Patient Safety

Keywords

mechanical restraints

antipsychotics

delirium

bCAM

hospital admissions

retrospective study

benzodiazepines

end-of-life care

restraint use

QT prolongation

Mechanical Restraint

Antipsychotic

Retrospective Cross-Sectional Study

Delirium

bCAM