Patient Safety in the Use of Mechanical Restraints: Regulatory Compliance among Hospitals in the City of Buenos Aires and Proposal for Its Improvement

Introduction: Mechanical or physical restraint is an exceptional therapeutic resource to immobilize a subject and thus guarantee the safety of the patient and/or third parties in the face of high-risk behaviors, but it entails multiple crossings (bioethical, philosophical, medical, psychological, legal). Framed in the so-called “safety culture” developed by the WHO, based on the Protocol for its implementation of the CABA and attentive to its frequent use in CABA by different hospital services (medical clinic, geriatrics, intensive care and medical guards) we consider it necessary its study in terms of compliance with the risks it entails and its management. Objectives: Identify regulatory compliance with the GCABA Mechanical restraint (MR) Protocol from a patient safety perspective, as well as describe the clinical and medicolegal aspects, and propose the usefulness of a tool for its management and control. Methodology: Observational, descriptive, transversal and prospective work through the analysis of Clinical Records with indication of MR using a rubric-type form. 177 cases were analyzed between September-November 2023 from three hospitals of the Government of the City of Buenos Aires, statistical parameters were applied and graphs were made. Results: Only 12.99% complied with the Protocol. In the mental health specialized hospital compliance was almost 5 times greater than in the general one, and in the emergency services compliance was 12 times greater than in Inpatient services. We found that the start or end time of MR was not recorded and only 43% described the causes/justifications for the indication (mostly in Emergency and Specialized hospitals), with the MR average time being shorter in Emergency. Conclusions: Only 1.3 out of 10 patients reliably completed the Protocol and it was mostly in the mental health specialized hospital and the emergency services. The results show non-compliance behavior in the application and management of the risk that the use of mechanical restraints entails, being causes for criminal litigation. We consider that the checklists are useful to complete the Protocol and thus provide security to patients and professionals.