Reducing physical restraint use in residential aged care: implementation of an evidence-based approach to improve...

Background  This paper describes the approach taken by three high care residential facilities in reducing physical restraint use and improving practice when physical restraint is used as a care strategy. At the time of the project these three facilities provided care for 174 residents, with over half of the residents having a diagnosis of dementia. Method  A process of audit and feedback was used to identify initial compliance with best practice and facilitate identification of barriers to changing and improving clinical care. Results  Gaps were found in the areas of organisational documentation (including policy, procedures, forms and information for residents and their families) and staff education on the topic of physical restraint. Once these gaps were known, the task was to develop strategies to address the needs of three stakeholder groups: individual clinicians, residents and their families, and the organisation as a whole. Conclusion  The paper shows the advantages of auditing compliance with evidence-based criteria as a measure of improvements in clinical care, and describes the changes implemented as a means of improving practice and reducing physical restraint use. The results show that the process has been effective in achieving results in the short term, with large increases in the area of staff education, and improvements in the assessment of people identified as possibly requiring restraint. Future plans for sustaining and consolidating change and moving forward with improvements are discussed. The results so far have been encouraging and the organisation is committed to continue to improve compliance with best practice with the vision of eventually achieving restraint-free care environments.