Excellence Every Day

EXCELLENCE EVERY DAY PORTAL

Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.

A focus on restraints — balancing the safety needs of patients with the least restrictive methods

AN MGH NARRATIVE

"I work in an environment of very ill patients who often have multiple invasive devices that are not only imperative to sustaining life, but can do real and permanent harm if removed by the patient. As many as 2 out of 3 patients in the ICU will be delirious at some point, which can make it impossible for them adequately weigh the consequences of their actions. All a confused, delirious patient in an ICU knows is that there is a tube sticking down his throat and he would like it out, now.... more

Jeanne Dolan, RN, MSN, staff nurse, Surgical ICU

MGH RESTRAINT RESOURCES

		MGH Restraint Toolkit Restraint Use and Documentation: Key Points Patients in Restraints: Changes effective 11/30/10 Restraint Use and Documentation: Key Points What Constitutes a New Episode of Restraint Restraint Chart Check Tool Sample Non-behavioral Note Sample Behavioral Note Excellence Everyday Regulatory Readiness Resource Guide Literature Review Joint Commission Accreditation Manual HealthStream Offerings (internal access only) MGH 2011 Restraint Module Regulatory Compliance Required MGH Restraint Training Patient Restraint and Seclusion in the Acute Care Setting MGH Contacts: Restraint Champions - Collaborative Governance Restraint and Solutions Team Members

THE DATA

IMPROVEMENT INITIATIVES

FYIs

MGH Restraint Utilization
Percentage of Patients With
Physical Restraints (Limb and Vest)

Oct.-Dec. 2011
Adult	MGH	NDNQI
Critical Care	18.18	17.85
Surgical	0.42	0.56
Medical	0.36	0.75
Med-Surg	0.00	0.64

Jul-Sept 11
Adult	MGH	NDNQI
Critical Care	19.48	18.33
Surgical	0.00	0.43
Medical	1.71	0.79
Med-Surg	5.45	0.90

NDNQI Benchmark:
hospitals with 500+ beds
Green = Favorable
Red = Unfavorable

IN THE NEWS
Christian Health Care Center in Wyckoff, N.J., received an award from Healthcare Quality Strategies Inc. for meeting targeted improvement rates established by Centers for Medicare & Medicaid Services for physical-restraint reduction. -Nurse.com, July 25, 2011

Overview
MGH strives to reduce the use of restraint across patient care areas and identify safer interventions for our patients whose behaviors put them at risk for injury. Success in this endeavor requires a comprehensive approach with attention to regulatory and professional standards, healthcare team knowledge and attitudes, practice traditions, scientific evidence, and individual patient needs. A partnership among clinical, regulatory, and technical experts helps to ensure that systems are in place to support effective communication and compliance. This partnership is reflected in two MGH committees working hand in hand: The Collaborative Governance Restraint Reduction Committee and Restraint and Seclusion Solutions Team.

MGH Restraints and
Seclusion Solution Team
There are ethical concerns and patient safety risks associated with restraint use in acute care hospitals. These concerns are reflected in CMS and Joint Commission standards which are very specific, particularly in the area of nursing and physician assessment and documentation. The MGH Restraints and Seclusion Solution Team, co-led by Carol Camooso Markus, RN and Tony Weiss, MD, is a multidisciplinary team of nurses, physicians, and administrative staff, convened in 2010 to explore innovative ways to meet regulatory requirements. Building on earlier work done in the Emergency Department, the team developed templates to provide triggers for clinician assessment and documentation. Outcomes to date include the recently implemented restraint “stickers” for nurses, POE enhancements for providers, and nurse and provider educational efforts. Current monitoring data shows further improvement is necessary. This Team will continue explore ways to promote compliance and educate clinicians.
More about the MGH Restraints and Seclusion Solution Team

Policies, Procedures & Guidelines:
(internal access only)

Restraint and Seclusion, Clinical Policy and Procedure Manual

Patient in Behavioral Restraints or Seclusion Problem/Outcome/Intervention Sheet

Practice & Quality Subcommittee:
Restraint Usage -
Meets: 3rd Tuesday monthly
1:00pm-3:00pm
Yawkey 2-210
Conference Room

SPOTLIGHT ON PRACTICE

		Effects of Sensory Interventions on an Inpatient Psychiatric Unit A patient’s experience of hospitalization and the symptoms related to mental illness may reduce the capacity to manage negative moods and emotions and lead to a loss of behavioral control. This, in turn, may result in the use of patient restraints and/or seclusion to maintain patient safety....more Blake 11, Inpatient Psychiatric Unit


EXTERNAL REVIEWERS
	Complying with The Joint Commission Standards on Restraints and Seclusion (2002): The use of restraints and seclusion presents one of the most complex issues in clinical care - one requiring a delicate balance between safety and rights. Joint Commission Accreditation Manual			Magnet Recognition The American Nurses Credentialing Center (ANCC) requires Magnet-designated organizations to track nationally-benchmarked nursing sensitive indicators (NSIs) to continually inform improvement efforts related enhance patient outcomes. Examples of NSIs include, but are not limited to: patient falls, hospital-acquired pressure ulcers, blood stream infections, ventilator-associated pneumonia, and restraint use.

GLOSSARY OF TERMS

click here...

There are numerous terms and acronyms in healthcare that may be unfamiliar. Please click here to visit a Glossary of Terms that may be helpful. And please email any suggested additions.

This month's featured term: Restraint
Per The Joint Commission, in its broadest sense, restraint is the direct application of physical force to a patient with or without the patient's permission to restrict his or her freedom of movement.


Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.

If you have questions or suggestions related to the EED portal, please contact Georgia Peirce at (617) 724-9865 or via email at gwpeirce@partners.org.

updated 4/4/12

Massachusetts General Hospital 55 Fruit Street, Boston MA 02114 / (617) 726-2000 / TDD: 617-724-8800