Restraint reduction reduces serious injuries among nursing home residents.

OBJECTIVES

To describe how removing physical restraints affected injuries in nursing home settings.

DESIGN

A 2-year prospective study of an educational intervention for physical restraint reduction.

SETTING

Sixteen diverse nursing homes with 2075 beds in California, Michigan, New York, and North Carolina.

PARTICIPANTS

Study A: 859 residents who were physically restrained at the onset of the intervention on October 1, 1991. Study B: all residents who occupied the 2075 beds in the 16 facilities 3 months before the intervention and 3 months after its completion.

INTERVENTION

Educational program for nursing home staff followed by quarterly site consultations to participating nursing homes.

MAIN OUTCOME MEASURES

Rate of physical restraint use and injuries.

RESULTS

Study A: Serious injuries declined significantly among the 859 residents restrained initially when restraint orders were discontinued (X2 = 6.2, P = .013). Study B: During the intervention period, physical restraint use among the 2075 residents decreased from 41% to 4%, a 90% reduction. The decrease in the percentage of injuries of moderate to serious severity was significant (i.e., 7.5% vs 4.4%, P2-tail = .0004) as was the rate of moderate and serious injuries combined (Rate Ratio = 1.580, P2-tail = .0033).

CONCLUSIONS

A substantial decrease in restraint use occurred without an increase in serious injuries. Although minor injuries and falls increased, restraint-free care is safe when a comprehensive assessment is done and restraint alternatives are used.