Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: Use of restraining therapies—American College of Critical Care Medicine Task Force 2001–2002

Abstract

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 member- ship of the American College of Critical Care Medicine (ACCM), the Society of Critical Care Medicine (SCCM), and the American As- sociation of Critical Care Nurses (AACN). Evidence: The task force members reviewed the published liter- ature (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 www.cochrane.org). Consensus Process: The task force met as a group and by teleconference to identify the pertinent literature and derive con- sensus 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 consen- sus 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 docu- ment 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. (Crit Care Med 2003; 31:2665-2676)