MODELS OF GERIATRIC PRACTICE: Progress Toward a Restraint‐Free Environment in a Large Academic Nursing Facility

Abstract

OBJECTIVE: To review the implementation and evolution of a successful physical restraint reduction program in a large nursing facility. INTERVENTION AND MEASUREMENTS: An initiative to reduce physical restraint began in March of 1990 with formation of a Restraint Review Committee (RRC), which developed and guided a program of inservice education, policy change, and procedural innovation. Progress was measured by monthly prevalence surveys of restraint use, both unit‐specific and facility‐wide. PATIENTS AND SETTING: The study took place in an 816‐bed not‐for‐profit nursing facility with academic affiliation and closed medical staff. Mean age of residents was 85.5; 74% were female and 26% male. RESULTS: Physical restraint prevalence in our facility was reduced from 39% to 4% over 3 years, with marked decrease in variation among nursing units. Prevalence initially decreased to 20% after policy modifications and inservice education programs. Further innovations in procedure and policy resulted in continued reduction of physical restraint to 4%. The facility‐wide rate of falls and accident‐related injuries did not change over the 3‐year period. Decrease in physical restraint was not accompanied by a change in the percentage of residents prescribed psychotropic medications such as benzodiazepines and neuroleptics. CONCLUSIONS: In response to the mandate to provide a least‐restrictive environment, our institution has developed a successful system resulting in a dramatic reduction in physical restraint use. Changes in institutional culture and barriers to change are discussed, as well as issues of cost and generalizability. J Am Geriatr Soc 43:914–918, 1995.

Patient injury and physical restraint devices: a systematic review

“…However, the findings of the impact of restraint minimization on injury are contradictory. Some studies report no change in the incidence of falls (Werner et al . 1994, Levine et al .…”

“…1994). Two studies suggest that the incidence of serious injury does not change following a reduction in restraint use (Levine et al . 1995, Si et al .…”