Elizabeth Kvale1,2, J Nicholas Dionne-Odom3, David T Redden1,4, F Amos Bailey1,2, Marie Bakitas1,3, Patricia S Goode1,2, Beverly R Williams1,2, Kathlyn Sue Haddock5, Kathryn L Burgio1,2. 1. 1Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama. 2. 2Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama. 3. 3School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama. 4. 4Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama. 5. 5William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina.
Abstract
BACKGROUND: The use of physical restraints in dying patients may be a source of suffering and loss of dignity. Little is known about the prevalence or predictors for restraint use at end of life in the hospital setting. OBJECTIVE: The objective was to determine the prevalence and predictors of physical restraint use at the time of death in hospitalized adults. METHODS: Secondary analysis was performed on data from the "Best Practices for End-of-Life Care for Our Nation's Veterans" (BEACON) trial conducted between 2005 and 2011. Medical record data were abstracted from six Veterans Administration Medical Centers (VAMCs). Data on processes of care in the last seven days of life were abstracted from the medical records of 5476 who died in the six VAMCs. We prospectively identified potential risk factors for restraint use at the time of death from among the variables measured in the parent trial, including location of death, medications administered, nasogastric tube, intravenous (IV) fluids, family presence, and receipt of a palliative care consultation. RESULTS: Physical restraint use at time of death was documented in 890 decedents (16.3%). Restraint use varied by location of death, with patients in intensive settings being at higher risk. Restraint use was significantly more likely in patients with a nasogastric tube and those receiving IV fluids, benzodiazepines, or antipsychotics. CONCLUSIONS: This is the first study to document that one in six hospitalized veterans were restrained at the time of death and to identify predictors of restraint use. Further research is needed to identify intervention opportunities.
BACKGROUND: The use of physical restraints in dying patients may be a source of suffering and loss of dignity. Little is known about the prevalence or predictors for restraint use at end of life in the hospital setting. OBJECTIVE: The objective was to determine the prevalence and predictors of physical restraint use at the time of death in hospitalized adults. METHODS: Secondary analysis was performed on data from the "Best Practices for End-of-Life Care for Our Nation's Veterans" (BEACON) trial conducted between 2005 and 2011. Medical record data were abstracted from six Veterans Administration Medical Centers (VAMCs). Data on processes of care in the last seven days of life were abstracted from the medical records of 5476 who died in the six VAMCs. We prospectively identified potential risk factors for restraint use at the time of death from among the variables measured in the parent trial, including location of death, medications administered, nasogastric tube, intravenous (IV) fluids, family presence, and receipt of a palliative care consultation. RESULTS: Physical restraint use at time of death was documented in 890 decedents (16.3%). Restraint use varied by location of death, with patients in intensive settings being at higher risk. Restraint use was significantly more likely in patients with a nasogastric tube and those receiving IV fluids, benzodiazepines, or antipsychotics. CONCLUSIONS: This is the first study to document that one in six hospitalized veterans were restrained at the time of death and to identify predictors of restraint use. Further research is needed to identify intervention opportunities.
Authors: Nathan M Stall; Hadas D Fischer; Kinwah Fung; Vasily Giannakeas; Susan E Bronskill; Peter C Austin; Jeremy N Matlow; Kieran L Quinn; Susan L Mitchell; Chaim M Bell; Paula A Rochon Journal: JAMA Netw Open Date: 2019-08-02
Authors: Li-Ting Kao; Kuo-Chen Cheng; Chin-Ming Chen; Shian-Chin Ko; Ping-Jen Chen; Kuang-Ming Liao; Chung-Han Ho Journal: Int J Environ Res Public Health Date: 2020-07-10 Impact factor: 3.390