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Progress toward a restraint-free environment in a large academic nursing facility
J M Levine1, V Marchello, E Totolos
1Jewish Home and Hospital for Aged, Bronx, New York 10468, USA.
Journal of the American Geriatrics Society
|August 1, 1995
Summary
A nursing facility successfully reduced physical restraint use from 39% to 4% in three years through a dedicated committee, policy changes, and staff education. This initiative improved patient care without increasing falls or psychotropic medication use.
Area of Science:
- Geriatric care and nursing home management
- Patient safety and quality improvement initiatives
Background:
- Physical restraints are often used in nursing facilities, raising concerns about patient rights and quality of care.
- There is a need for evidence-based strategies to reduce the use of physical restraints in long-term care settings.
Purpose of the Study:
- To review the implementation and evolution of a successful physical restraint reduction program in a large nursing facility.
- To assess the impact of the program on patient safety indicators and psychotropic medication use.
Main Methods:
- Formation of a Restraint Review Committee (RRC) to guide the initiative.
- Implementation of inservice education, policy changes, and procedural innovations.
- Monthly prevalence surveys to measure restraint use, falls, injuries, and psychotropic medication prescriptions.
Main Results:
- Physical restraint prevalence decreased from 39% to 4% over three years.
- No significant changes were observed in the facility-wide rates of falls or accident-related injuries.
- The percentage of residents prescribed psychotropic medications remained stable.
Conclusions:
- A comprehensive, multi-faceted approach can successfully reduce physical restraint use in nursing facilities.
- Achieving a least-restrictive environment is feasible and can be sustained.
- Institutional culture change and addressing barriers are crucial for program success and generalizability.