Purpose/Objectives:
To improve documentation for restraint practices, an online clinical documentation tool was developed incorporating Joint Commission regulatory standards of care for patients requiring medical-surgical care restraints.
Significance:
A comprehensive, systematic online clinical documentation process for restraint use supports quality and patient safety initiatives by measuring nursing practices and patient outcomes. An electronic system that compiles and tracks meaningful information allows the clinical nurse specialist (CNS) to examine and report trends over time and to address practice issues.
Design/Background/Rationale:
After critical appraisal of restraint documentation, a CNS-led Evidence-Based Practice Restraint Committee spearheaded an initiative to integrate paper documentation forms into an electronic record to facilitate efficiency and accuracy of data collection and allow real-time data retrieval for compiling reports.
Methods/Description:
A step-by-step process is presented describing how critical indicators were identified and how the tool was designed to guide evidence-based practice practice and to reflect best practice in restraint care. The clinical documentation tool was implemented by unit-based CNSs and used by clinical nurses on all nursing care units.
Findings/Outcomes:
The online format resulted in trends in documentation practices that showed greater than 30% improvement in several areas, including compliance with entries for date- and time-dependent assessments and interventions, patient demographics, nurses' signatures, and reasons for implementing restraints. Other components of documentation reflected dynamic enhancements in legibility, notations for least restrictive alternatives attempted, reassessments of patients in restraints, and family notification of need for restraint use.
Conclusions:
This electronic clinical documentation tool provides a comprehensive, structured format for clinical nurses to chronicle restraint use and compliance with safe nursing practices for patients who require restraints. The tool generates analyzable unit-specific and department-level data for CNSs to regularly assess restraint practices and report practice outcomes.
Implications for Practice:
A structured electronic online framework for restraint documentation assists clinical nurses to critically assess and reassess patients, determine a safe and least restrictive environment of care, and consider alternatives to restraints. Online restraint documentation provides opportunities for CNSs to access data, review restraint utilization, provide practice remediation, and formulate education and practice strategies to reduce or eliminate need for restraints.
Section Description
The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.
Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.
The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.