• Melanie Guenette, Lisa Burry, Alexandra Cheung, Tara Farquharson, Marlene Traille, Ioanna Mantas, Sangeeta Mehta, and Louise Rose.
• Melanie Guenette is a previous research coordinator at Mount Sinai Hospital, Toronto, Canada. Lisa Burry is a clinician scientist at the University of Toronto, and a clinical pharmacy specialist at Sinai Health System, Toronto, Canada. Alexandra Cheung is a clinical pharmacist at Sinai Health System. Tara Farquharson is a pharmacist at Hospital for Sick Children, Toronto, Canada. Marlene Traille is a clinical nurse specialist and Ioanna Mantas is a pharmacist at Sinai Health System. Sangeeta Mehta is an intensive care physician, Department of Medicine, Sinai Health System, and a professor of medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto. Louise Rose is the TD Nursing Professor in Critical Care Research, Sunnybrook Health Sciences Centre, Toronto, Canada, and an associate professor, University of Toronto.
• Am. J. Crit. Care. 2017 Sep 1; 26 (5): 380-387.

BackgroundRestraining therapies (physical or pharmacological) are used to promote the safety of both patients and health care workers. Some guidelines recommend nonpharmacological or pharmacological interventions be used before physical restraints in critically ill patients.ObjectivesTo characterize psychotropic drug interventions before and after use of physical restraints in critically ill adults receiving mechanical ventilation.MethodsA single-center, prospective, observational study documenting psychotropic drug use and Sedation-Agitation Scale (SAS) scores in the 2 hours before and the 6 hours after application of physical restraints.ResultsNinety-three patients were restrained for a median of 21 hours (interquartile range, 9-70 hours). Thirty percent of patients did not receive a psychotropic drug or had a drug stopped or decreased before physical restraints were applied. More patients received a psychotropic drug intervention after use of physical restraints than before (86% vs 56%, P = .001). Administration of opioids was more common after the use of physical restraints (54% vs 20% of patients, P = .001) and accounted for more drug interventions (45% vs 29%, P = .001). Fifty patients had SAS scores from both time periods; 16% remained oversedated, 24% were appropriately sedated, and 16% remained agitated in both time periods. Patients became oversedated (20%), more agitated (10%), less agitated (8%), and less sedated (6%) after restraint use.ConclusionsPsychotropic drug interventions (mostly using opioids) were more common after use of physical restraints. Some patients may be physically restrained for anticipated treatment interference without consideration of pharmacological options and without documented agitation.©2017 American Association of Critical-Care Nurses.

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