Authors: (including presenting author): :
Tsang LF(1), So KF(1), Ng CF(1), Cheung TP(1), Lo KP(1), Tong YK(1), Khaliah FG(2), Tang SK(3), Leung LM(1)
Affiliation: :
(1) Nursing Services Division, United Christian Hospital, Hospital Authority, Hong Kong Special Administrative Region
(2) Director System Policy Quality Improvement & Operations, Policy, at University Hospitals Health System, Northeast, OH
(3) Nursing Services Department, Hospital Authority Head Office, Hong Kong Special Administrative Region
Keyword 1: :
Physical restraint
Keyword 2: :
Assessment tool
Keyword 3: :
Restraint Decision Wheel
Keyword 4: :
Cluster randomized controlled trial
Introduction: :
Physical restraint has been used frequently in clinical settings. Nurses lack standardized, objective assessment instruments for making appropriate physical restraint decisions in general adult ward settings. A systematic review identified limited evidence-based assessment instrument to justify the use of physical restraint.
Objectives: :
To evaluate the effectiveness and user satisfaction of a validated evidence-based assessment instrument for reducing physical restraint use in general adult wards of an acute public hospital in Hong Kong.
Methodology: :
A single-blinded cluster randomized controlled trial following CONSORT guidelines was conducted across eight wards in Orthopaedics, Surgery, Medicine, and Geriatrics departments from April to June 2025. Wards were randomly assigned to intervention (the instrument with structured five-level decision framework based on a modified Restraint Decision Wheel (RDW) framework plus existing record form) or control (existing record form) groups. A total of 1,963 patients were centrally randomized with third party concealment.
Result & Outcome: :
The intervention group (n=986) and control group (n=977) showed comparable baseline characteristics. Intervention wards demonstrated significant restraint prevalence reduction from 14.89% to 12.1% (p=0.002), significantly lower than controls. Restraint incidence rates were similar between groups (17.0% vs 17.5%, p=0.774). The intervention group showed slightly shorter restraint duration and hospital stays without statistical significance. Staff satisfaction survey’s response rate was 37.3%. Nurses found the instrument clear and helpful and mean scores ranged from 3.55 to 4.13, indicating general satisfaction. The structured assessment instrument significantly reduced the prevalence of physical restraint in general acute adult wards, promoting safer and more ethical clinical practices. Despite increased administrative workload, nurses reported improved decision justification and increased use of alternatives. Broader implementation with ongoing refinement could further minimize unnecessary restraints while maintaining patient safety and outcomes.
