I'm finding in my literature review that isolation, delirium and actually restraints contribute to pt self extubation.

The factors like physical restraint, level of sedation, and activity and mental status of the patient ,Delirium and changing posture is also a risk factor. Patient’s distraction during physician rounds increases the incidence as well

Dr Sadaqa, these are the things I found in my literature review. In the current ICU we use wrist restraints which not only cause increase anxiety, skin break down and increase in delirium, it requires increases time in documentation and loss of time at bedside for both nurses and physicians. I suggested use of padded mitts that do not restrict patient movement and does not require restraint orders and documentation but restricts the possibility of patient grabbing at the ET and or other medical equipment but because of the added cost, these mitts will not be used. I also found that nurse and respiratory therapy lead weaning trials assisted in a decrease in intubation days.

Thank You for your input. Change is difficult.