Reducing and managing restraints in long-term-care facilities

Abstract

Objective: To evaluate a management system designed to improve staff adherence to a federal regulation that stated restrained residents should be released, exercised, and repositioned every 2 hours.

Design: A delayed intervention, controlled, cross-over design with three phases. During phase one, baseline, the length of intervals that residents remained in restraints was monitored. The intervention was implemented at site A in Phase two while site B remained in baseline. During Phase three, the intervention was replicated at site B.

Setting: Two long-term care proprietary nursing facilities.

Patients: Sixty-three physically restrained residents in the two facilities.

Intervention: The intervention was a system of restraint release using colored pads corresponding to specific hours. The management rule was that the resident should be on a different colored pad every 2 hours. Staff had to lift residents to place the pad, and the colors made the system easy for supervisors to check.

Main outcome measures: Checks by research personnel by black light and invisible ink, to detect movement of the knot tying the restraints.

Results: During the baseline phase, the majority of residents at both sites were inappropriately restrained longer than 2 hours (site A: 54.1%; site B: 60.1%). The percentage of residents restrained over 2 hours was significantly reduced during the intervention phase to 13.9% (site A) and 19.4% (site B). Three weeks after the end of the intervention, inappropriate use of restraints remained low, 14.2%, but rose to 47.7% after another 3 weeks.

Conclusion: The management system is an effective way to increase the consistency with which nursing-home staff release and reposition restrained residents.