Massachusetts General Hospital Patient Care Services
Excellence Every Day

EXCELLENCE EVERY DAY PORTAL 

click here

PCS Home Page Nursing Chaplaincy Institute for Patient Care Occupational Therapy Orthotics & Prosthetics Physical Therapy Respiratory Care Services Social Service Speech Language & Swallowing Disorders Clinical Resources MGH Internal Access Only
 
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.
Collaborative Governance Magnet Recognition Regulatory Readiness Innovation Units

Other Topics: Anticoagulation | CAUTI | Central Lines | Disabilities | Diversity | Downtime (internal access only) | Ebola Updates

eBridge | Ethics | Evidence-Based Practice | Fall Prevention | LOS (internal access only) | Pain | Patient Education/Health Literacy
Patient Experience | Pressure Ulcers | Process Improvement | Professional Development | Restraints | EED Home

Epic Documentation | Epic Communication

(internal access only)

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

MGH NARRATIVES
Kathryn Eagan headshot
Candice Couture, RN

Reducing length of stay one creative idea at a time
When you’re in need of acute care, the best place to be is in the hospital. But once the
urgency has passed, patients recover better in their own homes or in a less-acute care
facility. Staff on Ellison 12 recently employed a strategy in caring for Mr. J that both improved care and reduced the amount of time he spent in the hospital
. ... read more

Candice Couture, RN, staff nurse, General Medicine, and PCS Restraint Solutions in Clinical Practice Committee member


Inter-disciplinary collaboration inspires nonrestraint solution ... read more

Kathryn Eagan, RN, staff nurse, Respiratory Acute Care Unit (RACU)


Restraint Use in the Surgical ICU: How to balance out competing safety needs ... read more

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


Sometimes comfort comes in the form of trust, respect, and compassion ... read more

Katherine (O’Meara) Jacobson, RN, staff nurse, Cardiac Step Down Unit

MGH RESTRAINT RESOURCES
Restraint Care Model
THE DATA
IMPROVEMENT INITIATIVES
FYIs
MGH Restraint Utilization (adult units)
Percentage of Patients With
Physical Restraints (Limb and Vest)

TREND: Favorable. Majority of unit types (6/8) outperform the NDNQI comparative benchmarks for the most recent quarter.

CLICK HERE for additional data
Oct-Dec 2015
Adult
MGH
NDNQI
Critical Care
21.21
18.01
Medical
0.31
0.66
Med-Surg
4.84
1.08
Surgical
0.00
0.40
Psych 0.00
0.20

 

Jul-Sept 2015
Adult
MGH
NDNQI
Critical Care
13.68
16.78
Medical
0.61
0.69
Med-Surg
1.61
0.75
Surgical
0.40
0.32
Psych 0.00
0.12

 

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

 

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:
CG Restraint and Solutions in Clinical Practice
-
Meets: 3rd Tuesday monthly
1:00pm-3:00pm
Yawkey 2-210
Conference Room

IN THE NEWS
SPOTLIGHTS ON PRACTICE

Trialing Sensory-based Interventions in the SICU
The MGH Restraint Solutions in Clinical Practice Committee was formed in 2011 as part of an institution wide effort to safely reduce the use of restraints. One of the goals of this multidisciplinary team of nurses and occupational therapists is to assess the potential for sensory-based evaluation and interventions to prevent or reduce restraint use in the acute non-psychiatric inpatient units...more

Sensory Room photo

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

Joint Commission logo
National Patient Safety Goal 14.01.01
Pressure Ulcers (Risk assessment tools, preventative actions)

Joint Commission Accreditation Manual

CMS logo
Centers for Medicare and Medicaid Services (CMS)

Magnet Recognition

Magnet_logoThe American Nurses Credentialing Center (ANCC) requires Magnet-designated organizations to track nationally-benchmarked nursing sensitive indicators (NSIs) to continually inform improvement efforts related enhancing 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

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: Friction
Friction is defined as the resistance to motion in a parallel direction relative to the common boundary of two surfaces (NPUAP, 2007.) Friction is one of the two most common etiologies of superficial, top-down Stage 2 ulcers. The mechanism of injury associated with friction is abrasion of the epidermis, which is often caused by dragging the patient up in the bed or from one surface to another. Strategies to prevent friction injury include: 1) using the ceiling lift to reposition the patient, regardless of body habitus, 2) covering bony prominences with dressings (e.g. Mepilex Border Sacrum) that have slippery outer layer which decreases resistance, 3) moisturizing skin with cream containing silicon which decreases resistance (may complicate adherence of dressings with silicon at borders.

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 5/27/16

Home | Chaplaincy | Excellence Every Day Portal | Institute for Patient Care | Nursing | Occupational Therapy | Orthotics & Prosthetics | Physical Therapy

Respiratory Care | Social Service | Nursing | Speech Language Swallowing Disorders | Clinical Resources | Search PCS | Contact PCS

MGH Home Page | MGH Intranet | MassGeneral Hospital for Children | Partners Healthcare

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