Unrestrained pride: development of a protocol for a restraint free environment

This article describes one facility's experience in attempting to enhance compliance with nonrestraint policy. The importance of policy implementation is emphasized, particularly as it relates to nursing care. In response to a study which revealed that a large number of wheelchair restraints were being applied indiscriminately, the extended care facility developed a flow chart in order to facilitate appropriate decision making and assessment regarding safety and restraints. The flow chart/protocol was created to bridge the gap between the conceptual policy level and the procedures for restraint application and removal. It is based on the nursing process and is dependent on ongoing assessment of the resident's status. A survey carried out one year after the initial, pre-intervention survey revealed that only 6.4% of residents were restrained using wheelchair lap belts, compared to the previous 26%, identified as problematic at the outset of the study.