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Safe use of non-pharmacological interventions

Non-pharmacological interventions can be used in the ICU to reduce anxiety, pain, help sleep and avoid delirium. They may also be helpful in decreasing the amount of sedatives and analgesics required:

  • Reassurance and nursing presence
  • Minimal bed moves during ICU stay
  • Encourage family visiting and support
  • Frequent reminders of place and time
  • Re-establishment of the sleep-wake cycle
  • Promotion of a calm environment
  • Early mobilisation activities
  • Glasses, hearing aids, communication boards (and other methods of optimising communication)
  • Relaxation therapy, massage, music therapy and/or pastoral services

Physical restraint should only be used as a last resort. Restraint applied must be reasonable and abide by legal and ethical parameters. Restraint should only be used if there is a significant risk of physical injury or harm to patients/staff. Physical restraints may include the use of commercial gauze/cotton pads, crepe bandages, and padded gloves. A thorough risk assessment should be carried out prior to the use of any physical restraint. Patients who are restrained should have:

  • A thorough assessment to determine the cause of the challenging behaviour
  • Clear documentation of assessment and proposed action
  • The least restrictive method should be applied in the first instance (verbal communication, cote sides, guiding hands away from tubes/lines)
  • Care and attention taken to protect patient autonomy and dignity
  • 2-4 hourly monitoring for any pressure related injury
  • Need for physical restraint reviewed on a regular basis

(Bray et al, 2004)