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Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: Use of restraining therapiesAmerican College of Critical Care Medicine Task Force 20012002

Maccioli, Gerald A. MD, FCCM; Dorman, Todd MD, FCCM; Brown, Brent R. MD; Mazuski, John E. MD, PhD, FCCM; McLean, Barbara A. MN, CCRN, CCNS-NP, FCCM; Kuszaj, Joanne M. MSN, RN, CCRN; Rosenbaum, Stanley H. MD, FCCM; Frankel, Lorry R. MD, FCCM; Devlin, John W. PharmD, BCPS, FCCM; Govert, Joseph A. MD; Smith, Brian RCP, RRT; Peruzzi, William T. MD, FCCM

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Objective: To develop clinical practice guidelines for the use of restraining therapies to maintain physical and psychological safety of adult and pediatric patients in the intensive care unit.

Participants: A multidisciplinary, multispecialty task force of experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM), the Society of Critical Care Medicine (SCCM), and the American Association of Critical Care Nurses (AACN).

Evidence: The task force members reviewed the published literature (MEDLINE articles, textbooks, etc.) and provided expert opinion from which consensus was derived. Relevant published articles were reviewed individually for validity using the Cochrane methodology (http://hiru.mcmaster.ca/cochrane/ or http://www.cochrane.org).

Consensus Process: The task force met as a group and by teleconference to identify the pertinent literature and derive consensus recommendations. Consideration was given to both the weight of scientific information within the literature and expert opinion. Draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft then was reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council.

Conclusions: The task force developed nine recommendations with regard to the use of physical restraints and pharmacologic therapies to maintain patient safety in the intensive care unit.

From Critical Health Systems (GAM), Raleigh Practice Center, Raleigh, NC; Departments of Anesthesiology/Critical Care Medicine, Medicine, Surgery, and Nursing (TD), Johns Hopkins Hospital, Baltimore, MD; Internal Medicine Program (BRB), University of Oklahoma College of Medicine; Washington University School of Medicine (JEM), Atlanta Medical Center (BM), Atlanta, GA; Medical Surgical Intensive Care Unit (JMK), Rex Healthcare, Raleigh, NC; Department of Anesthesiology (SHR), Yale University School of Medicine; Stanford University (LRF); Tufts-New England Medical Center (JD), Boston, MA; Duke University Medical Center (JAG), Durham, NC; Northwestern Memorial Hospital (BLS), Chicago, IL; and Section of Critical Care Medicine (WTP).

These practice guidelines have been developed by a task force assembled by the American College of Critical Care Medicine of the Society of Critical Care Medicine and have been reviewed by the Society’s Council. These guidelines reflect the official opinion of the Society of Critical Care Medicine and should not be construed to reflect the views of the specialty boards or any other professional medical organization.

The task force developed nine recommendations with regard to the use of physical restraints and pharmacologic therapies to maintain patient safety in the intensive care unit.

© 2003 Lippincott Williams & Wilkins, Inc.