Because the hospital is a cancer center, "we explain to them that they might be at higher risk of confusion—this could be cancer tumor–related; chemotherapy can increase confusion—and also our patients can become very sick really quick at times during treatment, so they're more at risk of falling," says Bertini. "Empowering patients and family members from the get-go that they might become more confused and explaining the plan on how we'll work together as a team to address it immediately decreases anxiety of both the patient and their family members."
The program brought about some upgrades and continuous improvement plans to continue to achieve 100% accuracy. The facility replaced every bed in the hospital with new ones that have bed alarms. The beds now ring to the nurses' station so nursing staff will know right away if a patient is out of bed.
"We also educate the patient and family members so they know what those alarms are for—any alarm without explanation causes anxiety," says Bertini.
Every patient gets checked in on at least every hour and more often if they are at a higher risk.
Although the process ties into MRP initiatives, all of those involved with the restraint-free program at CTCA agree that going restraint-free is far more universal than that.
"As the [MRP] coordinator, I'd love to say we did it for MRP, but we did it more than five years ago because it's best for our patients," says Bertini. The organization has been on the MRP journey to excellence for two years, but the restraint-free policy has been working much longer than that.
Buy-in from nurses was no trouble. "As a matter of fact, some of our staff wondered why it took us until 2005 to become restraint-free," says Bertini. "As soon as we started the program, we had a successful immediate stop. Nurses were very proud and happy to have permission to go restraint-free."
The bottom line: It worked. CTCA at Midwestern has seen a dramatic decrease in fall injury rates, which it ties directly to the no-restraint program.
"We also see increased patient satisfaction," Bertini says. "Considering how sick our patients might be at any given time, our goal is to make it as safe and comfortable as possible. We continue quality checks with the restraint-free program and report back on quality to the board."
The program also benefited CTCA at Midwestern on a recent Joint Commission survey.
"We had Joint Commission review not long ago, and the surveyors were impressed that we don't restrain our ventilated patients. They had not seen an initiative like this," says Bertini. "They were very impressed with our process improvement."
Zeta-Sanchez summarizes the success of the program in four steps.
"We are very fortunate at CTCA at Midwestern that we've got a very active hospital board," says Bertini. "The nurses know all of the hospital board members. We're very comfortable reporting back our numbers. Every month, we are able to report back great success in maintaining the restraint-free environment. There is a lot of accountability in the CTCA environment."
Tips for success