Patient Safety Update
NEW OE Prompts Renewal of Restraint Orders
Information Systems upgraded BWH’s Order Entry (OE) to include prompts for physicians and nurse practitioners to review restraint orders and renew the order if indicated. This is an effort to improve patient safety and to better support timely orders and renewals for the use of restraints on inpatient units. The upgrade occurred the first week in November.
Restraints ordered for inpatients for medical or surgical reasons, or non-primary behavioral issues, remain effective for 24 hours. With the OE upgrades, the licensed practitioner who ordered the restraint will be prompted at the 12th hour of the order to evaluate whether to renew or discontinue the restraint.
Restraints ordered for violent or self-destructive behavior or primary behavioral issues, remain effective for four hours. However, with the changes, OE will prompt the ordering provider to evaluate the order at the second hour to either rewrite the order or discontinue it.
When a restraint comes up for renewal, the word “renewals” or the letter “R,” depending on how many other items are shown, will be displayed in the “Order Status” column next to the patient’s name on the pod monitor. Providers will receive the reminder when they open the order entry screen for that patient. It will be helpful for the nurse to know when the order will expire so that a discussion with the licensed practitioner can take place before a renewal is written.
With both behavioral and non-behavioral restraints, it is the responsibility of the ordering clinician to re-evaluate the patient’s need for continued restraint before renewing the order. Collaboration within the patient’s care team, including physicians, NPs, PAs and nurses, occurs during rounds and when evaluating whether to renew or discontinue a restraint order and to discuss alternatives.
“This initiative is an effort to promote collaborative discussions with the ordering clinician for better management of our patients,” said Mary Antonelli, MPH, RN, Nursing’s program manager for Quality.
BWH has made strides in the past two years to transition from the use of restraints to alternative techniques, with much of that work led by staff nurses. Prevalence rates for restraint use have decreased significantly in the last two years as alternatives to restraints, such as diversionary activities, are employed more regularly.
“Our responsibility is to keep our patients safe and comfortable. It’s become less about restraints and more about how we approach our patients experiencing various issues during hospitalization,” Antonelli said.