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Reducing Physical Restraints in Nursing Homes: A Report From Maria Wolff and Sanitas
Ruben Muñiz1, Sergio Gómez2, David Curto2
1Maria Wolff Foundation, Madrid, Spain.
Objective:
Physical restraints are associated with severe side effects and suffering. A comprehensive, person-centered, methodology was implemented in 41 Spanish nursing homes to safely eliminate restraints.
Methods:
Data were collected in 2 waves: September 2011 (at the beginning of the intervention, n = 4361) and September 2014 (n = 5051). Use of 10 different types of physical restraints was recorded, as well as frequency of psychotropic medication prescription, falls, and mortality.
Results:
Mean age was 83.4 (SD 8.5) and 63.5% of the residents had dementia. Frequency (95% confidence interval) of people having at least 1 restraint was reduced from 18.1% (17.0-19.3) to 1.6% (1.3-2.0). Use of benzodiazepines was also reduced, with no significant changes in other psychotropic medications and mortality. The rate of total falls increased from 13.1% (12.1-14.1) to 16.1% (15.1-17.1), with no significant increase in injurious falls.
Conclusion:
Physical restraints can almost completely be eliminated with reasonable levels of safety.