Influencing factors of the implementation of mechanical restraint in open psychiatric ward: a retrospective study (2016-2021).

backgroundMechanical restraint, a widely utilized yet contentious restrictive intervention in psychiatric practice, adversely affects both physical and psychological well-being of patients. Understanding the determinants associated with its implementation is crucial for reducing its clinical application. Current studies have primarily evaluated factors influencing mechanical restraint use and related organizational adaptations, but these investigations are limited to short-term observations. Furthermore, research examining correlates in patients subjected to recurrent mechanical restraint episodes in open psychiatric wards remains scarce, with biological contributing factors particularly lacking empirical evidence.

objectiveThis study aimed to analyze differences between inpatients experiencing single versus multiple restraint episodes in the open psychiatric ward setting and identify factors associated with multiple restraint occurrences.

methodsThis study is a retrospective analysis of electronic health record data from patients who underwent mechanical restraint in the open psychiatric ward of a Class III Grade A general hospital in China between 2016 and 2021. The data encompassed sociodemographic information, clinical characteristics, and biological indicators.

resultsThe study included a total of 449 patients who underwent mechanical restraint during hospitalization. Of these, 63.5% experienced a single episode of restraint, while 36.5% experienced multiple episodes. Furthermore, compared to patients with a single episode of mechanical restraint, those with multiple episodes exhibited a significantly earlier timing of the first restraint (p = 0.011), a prolonged hospital stay (p = 0.044), and relatively higher creatine kinase levels (p = 0.008). Multivariate analysis identified the timing of restraint (OR: 0.947, p = 0.005) and the duration of hospitalization (OR: 1.034, p = 0.003) as significant predictors of multiple restraint episodes.

conclusionAmong psychiatric inpatients in open wards, those subjected to multiple restraints exhibited earlier occurrence of the first restraint after admission, prolonged hospital stays, and relatively higher serum creatine kinase levels at admission. These findings suggest that in clinical practice, repeated restraint may potentially prolong hospitalization duration. Monitoring serum creatine kinase levels at admission may aid in identifying patients at risk for repeated restraints. Furthermore, early risk identification and the implementation of alternative interventions are critical to reducing the necessity for restraint interventions.